Boston—Despite common misconceptions, major traumatic injury patients who receive new prescriptions for opioids rarely end up using the painkillers long term, according to a new study.
Research results, presented recently at the 2016 Clinical Congress of the American College of Surgeons, note that nearly three of four patients in that situation discontinue use of the drug by 1 month after hospital discharge. A year later, only about 1% were still taking opioids such hydrocodone, oxycodone, morphine, and fentanyl, according to the study led by researchers from Brigham and Women’s Hospital and Harvard Medical School.
“We were really surprised by how low the numbers were for long-term opiate use,” said senior investigator Andrew Schoenfeld, MD. “It appears that traumatic injury is not a main driver for continued opioid use in patients who were not taking opioids prior to their injuries.”
“Our findings in patients who sustain traumatic injury contradict the popular narrative about the role that appropriate use of opioids may play in the rate of opioid abuse in this country,” he added.
For the study, researchers employed the 2007 to 2013 database of TRICARE, the Department of Defense healthcare system that insures active-duty military, reserve members, retired veterans, and their dependents. Because most TRICARE beneficiaries are currently civilians, Schoenfeld said the study findings are generalizable to the U.S. population.
The study, which was presented by co-author Muhammad Ali Chaudhary, MBBS, focused on 15,369 patients aged 18 to 64 years with an Injury Severity Score of >9 and who had not filled an opiate prescription within 6 months before their injuries. Results indicate that, although more than half of the patients in the study filled at least one opiate prescription soon after discharge, only 8.9% continued to fill opiate prescriptions 3 months later, according to researchers.
Prescription painkiller use rates continued to drop to 3.9% at 6 months and to 1.1% after a year, the study points out.
Older age, from 45 to 64, was one of the factors increasing the risk of long-term use of opiates after the initial prescription, according to the statistical analysis. Lower socioeconomic status—essentially enlisted junior service members compared with officers in this study—and hospitalization longer than 2 weeks also were linked to longer use of opioids.
“We wish to emphasize that health care providers should not withhold opiate painkillers because a patient has any of the identified risk factors from this study,” Schoenfeld emphasized. “At-risk patients can benefit from closer follow-up with their health care providers and, for those at high risk, a referral to the hospital's pain management service.”
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