TY - JOUR
T1 - Predicting at-risk opioid use three months after ed visit for trauma
T2 - Results from the AURORA study
AU - Punches, Brittany E.
AU - Stolz, Uwe
AU - Freiermuth, Caroline E.
AU - Ancona, Rachel M.
AU - McLean, Samuel A.
AU - House, Stacey L.
AU - Beaudoin, Francesca L.
AU - An, Xinming
AU - Stevens, Jennifer S.
AU - Zeng, Donglin
AU - Neylan, Thomas C.
AU - Clifford, Gari D.
AU - Jovanovic, Tanja
AU - Linnstaedt, Sarah D.
AU - Germine, Laura T.
AU - Bollen, Kenneth A.
AU - Rauch, Scott L.
AU - Haran, John P.
AU - Storrow, Alan B.
AU - Lewandowski, Christopher
AU - Musey, Paul I.
AU - Hendry, Phyllis L.
AU - Sheikh, Sophia
AU - Jones, Christopher W.
AU - Kurz, Michael C.
AU - Gentile, Nina T.
AU - McGrath, Meghan E.
AU - Hudak, Lauren A.
AU - Pascual, Jose L.
AU - Seamon, Mark J.
AU - Harris, Erica
AU - Chang, Anna M.
AU - Pearson, Claire
AU - Peak, David A.
AU - Merchant, Roland C.
AU - Domeier, Robert M.
AU - Rathlev, Niels K.
AU - O’Neil, Brian J.
AU - Sanchez, Leon D.
AU - Bruce, Steven E.
AU - Pietrzak, Robert H.
AU - Joormann, Jutta
AU - Barch, Deanna M.
AU - Pizzagalli, Diego A.
AU - Smoller, Jordan W.
AU - Luna, Beatriz
AU - Harte, Steven E.
AU - Elliott, James M.
AU - Kessler, Ronald C.
AU - Ressler, Kerry J.
AU - Koenen, Karestan C.
AU - Lyons, Michael S.
N1 - Funding Information:
This manuscript was in part funded by NIDA K08 DA049948. The parent study from which data was obtained for this analysis was funded by NIMH U01MH110925, the US Army Medical Research and Material Command, The One Mind Foundation, and The Mayday Fund. Verily Life Sciences and Mindstrong Health provided hardware and software used to perform study assessments. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: Conflict of Interest: In the last three years Dr. Clifford has received research funding from the NSF, NIH and LifeBell AI, and unrestricted donations from AliveCor, Amazon Research, the Center for Discovery, the Gordon and Betty Moore Foundation, MathWorks, Microsoft Research, the Gates Foundation, Google, One Mind Foundation, and Samsung Research. Dr Clifford has financial interest in AliveCor, and receives unrestricted funding from the company. He also is the CTO of MindChild Medical and CSO of LifeBell AI and has ownership in both companies. These relationships are unconnected to the current work. In the past three years, Dr. Germine has served on the Scientific Advisory Board of Sage Bionetworks, for which she received a small honorarium. She also receives grant support from NIH. Dr. Rauch reports grants from NIH during the conduct of the study; personal fees from SOBP (Society of Biological Psychiatry) paid role as secretary, other from Oxford University Press royalties, other from APP (American Psychiatric Publishing Inc.) royalties, other from VA (Veterans Administration) per diem for oversight committee, and other from Community Psychiatry paid board service, including equity outside the submitted work; and Leadership roles on Board or Council for SOBP, ADAA (Anxiety and Depression Association of America), and NNDC (National Network of Depression Centers). Sophia Sheikh has received funding from the Florida Medical Malpractice Joint Underwriter’s Association Dr. Alvin E. Smith Safety of Healthcare Services Grant; Allergan Foundation; the NIH/NIAfunded Jacksonville Aging Studies Center (JAX-ASCENT; R33AG05654); and the Substance Abuse and Mental Health Services Administration (1H79TI083101-01); and the Florida Blue Foundation. Christopher Jones has been an investigator on studies funded by Roche Diagnostics, AstraZeneca, Janssen, and Hologic Inc, for which my department has received research funding. No direct conflicts related to this paper, and no ongoing conflicts. Dr. Joormann receives consulting payments from Janssen Pharmaceuticals. Over the past 3 years, Dr. Pizzagalli has received consulting fees from Albright Stonebridge Group, BlackThorn Therapeutics, Boehringer Ingelheim, Compass Pathway, Concert Pharmaceuticals, Engrail Therapeutics, Neurocrine Biosciences, Otsuka Pharmaceuticals, and Takeda Pharmaceuticals; one honorarium from Alkermes, and research funding from NIMH, Dana Foundation, Brain and Behavior Research Foundation, and Millennium Pharmaceuticals. In addition, he has received stock options from BlackThorn Therapeutics. J Elliott reports support from the National Institutes of Health (NIH) through Grant Numbers R01HD079076 & R03HD094577: Eunice Kennedy Shriver National Institute of Child Health & Human Development; National Center for Medical Rehabilitation Research. He also reports funding from New South Wales Health, Spinal Cord Injury Award (2020-2025) and consulting fees (< $15,000 per annum) from Orofacial Therapeutics, LLC. In the past 3 years, Dr. Kessler was a consultant for Datastat, Inc., Holmusk, RallyPoint Networks, Inc., and Sage Pharmaceuticals. He has stock options in Mirah, PYM, and Roga Sciences. Dr. Ressler has received consulting income from Alkermes and Takeda, research support from NIH, Alkermes, Genomind and Brainsway, and he has served on advisory boards for Takeda, Resilience Therapeutics, Janssen and Verily/Google.
Publisher Copyright:
© 2022 Punches et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2022/9
Y1 - 2022/9
N2 - Objective Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use. Methods Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U. S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed for euphoria) in the 30 days before enrollment, and missing or incomplete data regarding opioid exposure or pain. We used multivariable logistic regression to assess the relationship between ED opioid exposure and at-risk opioid use, defined as any self-reported non-medical opioid use after initial ED encounter or prescription opioid use at 3-months. Results Of 1441 subjects completing 3-month follow-up, 872 participants were included for analysis. At-risk opioid use occurred within 3 months in 33/620 (5.3%, CI: 3.7,7.4) participants without ED opioid analgesic exposure; 4/16 (25.0%, CI: 8.3, 52.6) with ED opioid prescription only; 17/146 (11.6%, CI: 7.1, 18.3) with ED opioid administration only; 12/90 (13.3%, CI: 7.4, 22.5) with both. Controlling for clinical factors, adjusted odds ratios (aORs) for at-risk opioid use after ED opioid exposure were: ED prescription only: 4.9 (95% CI 1.4, 17.4); ED administration for analgesia only: 2.0 (CI 1.0, 3.8); both: 2.8 (CI 1.2, 6.5). Conclusions ED opioids were associated with subsequent at-risk opioid use within three months in a geographically diverse cohort of adult trauma patients. This supports need for prospective studies focused on the long-term consequences of ED opioid analgesic exposure to estimate individual risk and guide therapeutic decision-making.
AB - Objective Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use. Methods Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U. S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed for euphoria) in the 30 days before enrollment, and missing or incomplete data regarding opioid exposure or pain. We used multivariable logistic regression to assess the relationship between ED opioid exposure and at-risk opioid use, defined as any self-reported non-medical opioid use after initial ED encounter or prescription opioid use at 3-months. Results Of 1441 subjects completing 3-month follow-up, 872 participants were included for analysis. At-risk opioid use occurred within 3 months in 33/620 (5.3%, CI: 3.7,7.4) participants without ED opioid analgesic exposure; 4/16 (25.0%, CI: 8.3, 52.6) with ED opioid prescription only; 17/146 (11.6%, CI: 7.1, 18.3) with ED opioid administration only; 12/90 (13.3%, CI: 7.4, 22.5) with both. Controlling for clinical factors, adjusted odds ratios (aORs) for at-risk opioid use after ED opioid exposure were: ED prescription only: 4.9 (95% CI 1.4, 17.4); ED administration for analgesia only: 2.0 (CI 1.0, 3.8); both: 2.8 (CI 1.2, 6.5). Conclusions ED opioids were associated with subsequent at-risk opioid use within three months in a geographically diverse cohort of adult trauma patients. This supports need for prospective studies focused on the long-term consequences of ED opioid analgesic exposure to estimate individual risk and guide therapeutic decision-making.
UR - http://www.scopus.com/inward/record.url?scp=85138471840&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0273378
DO - 10.1371/journal.pone.0273378
M3 - Article
C2 - 36149896
AN - SCOPUS:85138471840
SN - 1932-6203
VL - 17
JO - PLoS ONE
JF - PLoS ONE
IS - 9 September
M1 - e0273378
ER -