Predictors Of Substance Use Disorders And Overdose Following Adolescent Trauma
*Teresa M Bell1, *Jodi Raymond1, Ashley Vetor1, Zackary Adams1, *Thomas Rouse1, *Rita Burke2, Aaron Carroll1
1Indiana University, Indianapolis, IN;2UCLA Children's Hospital, Los Angelos, CA
BACKGROUND: Approximately 1 in 8 injured adolescents are diagnosed with a substance use disorder (SUD) and 1 in 10 experience an overdose (OD). Recently, state laws have become more restrictive on opioid prescribing for treating acute pain. However, prior studies found that 1 in 8 adolescents were still using opioids 12 months after hospital discharge for injury. This study aims to determine if outpatient opioid prescriptions are predictive of SUD diagnosis or OD in the 5 year period following hospital discharge.
METHODS: Our cohort consisted of 736 patients ages 12-18 admitted for trauma from 2011-2013. We examined 5 years of regional health information exchange records containing data on prescription drug and health service utilization. We used logistic regression to determine the odds of SUD and OD based on the number of outpatient opioid prescriptions filled at 3, 6, 12, 24, 36, and 48 months. Models adjusted for age, race, injury severity/mechanism, surgery, insurance, rural/urban county, and depression/PTSD diagnoses.
RESULTS: At 3 months, 30.3% of patients had at least 1 prescription opioid refill. Each prescription opioid refill in the first 3 months after discharge increased the likelihood of SUD diagnosis by 55% (OR:1.55, CI:1.04-2.32). Odds of OD were significantly increased with each opioid refill at 24, 36, and 48 months (p=0.016, 0.017, and 0.025).
CONCLUSIONS: Short-term outpatient opioid prescribing was predictive of developing a substance use disorder, while long-term prescribing was predictive of experiencing an overdose.
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