Trauma Research Department, Swedish Medical Center, Englewood, CO, 80113, United States; Trauma Research Department, St. Anthony Hospital, Lakewood, CO, 80228, United States; Trauma Research Department, Medical City Plano, Plano, TX, 75075, United States; Trauma Research Department, Penrose Hospital, Colorado Springs, CO, 80907, United States.
Trauma Services Department, Swedish Medical Center, Englewood, CO, 80113, United States.
Injury. 2019 May;50(5):1058-1063. doi: 10.1016/j.injury.2019.01.003. Epub 2019 Jan 8.
Substance use and abuse may have the significant, but unanticipated, consequence of lessening the efficacy of opioid analgesics for acute pain management. We hypothesized that pre-injury substance use increases opioid analgesic consumption following traumatic injury.
This retrospective multi-institutional pilot study included admitted patients to four level 1 trauma centers with vehicular trauma over four months (n = 176). We examined the effect of positive urine drug screen (UDS; 7-drug panel, examined individually and combined, yes/no) and positive blood alcohol content (BAC, ≥80 mg/dL) on pain management with opioid analgesics over the hospital stay. Average daily opioid consumption was examined using a repeated measures mixed model, by positive UDS and BAC findings, adjusting for age, injury severity score, and non-opioid analgesia. Opioid analgesics were converted to milligram morphine equivalents (MME) and analyzed with a square-root transformation due to non-normality.
A positive drug or alcohol test was reported in 33.5% (59/176), including 12.5% (n = 22) with positive UDS and 26% (n = 45) with a positive BAC. There were no differences in gender, injury severity scores, Glasgow coma scores, or cause of vehicular trauma between substance users and non-users; only age was significantly different. Patients with a positive UDS consumed significantly more opioids compared to those with a negative UDS (34.7 MME vs. 24.7 MME, p = 0.04), after adjustment. Individually, detection of opiates, THC, cocaine, and amphetamines were associated with increased opioid consumption compared to their UDS negative counterparts; on the other hand, benzodiazepines and alcohol intoxication were associated with reduced opioid consumption during the course of hospitalization. However, none of the individual UDS results reached statistical significance. The largest effect of all the individual drugs was with opiates, which was associated with a borderline significant increase in opioid analgesic consumption (p = 0.06).
Our preliminary data suggest drug use may significantly alter acute pain management following traumatic injury, corresponding to 40% increase in opioid analgesia for substance users than non-users. These results may have broad reaching implications because of the high prevalence of substance use in the trauma population.
物质使用和滥用可能会对急性疼痛管理中的阿片类镇痛药的疗效产生显著但未预料到的影响。我们假设受伤前的物质使用会增加创伤后阿片类镇痛药的消耗。
这项回顾性多机构试点研究纳入了四个一级创伤中心在四个月内因车辆创伤而入院的患者（n=176）。我们研究了尿液药物筛查阳性（7 药物检测板，分别和联合检测，阳性/阴性）和血液酒精含量阳性（BAC≥80mg/dL）对住院期间阿片类镇痛药疼痛管理的影响。通过阳性 UDS 和 BAC 结果，使用重复测量混合模型检查平均每日阿片类药物消耗，同时调整年龄、损伤严重程度评分和非阿片类镇痛药。由于非正态性，将阿片类镇痛药转换为毫克吗啡当量（MME）并进行平方根转换进行分析。
报告了 33.5%（59/176）的药物或酒精检测阳性，其中 12.5%（n=22）的 UDS 阳性和 26%（n=45）的 BAC 阳性。物质使用者和非使用者在性别、损伤严重程度评分、格拉斯哥昏迷评分或车辆创伤原因方面无差异；仅年龄存在显著差异。与 UDS 阴性者相比，UDS 阳性者的阿片类药物消耗明显更多（34.7MME 比 24.7MME，p=0.04），调整后。单独检测阿片类药物、THC、可卡因和安非他命与 UDS 阴性者相比，阿片类药物消耗增加有关；另一方面，苯二氮䓬类药物和酒精中毒与住院期间阿片类药物消耗减少有关。然而，单独的 UDS 结果均未达到统计学意义。所有个体药物中影响最大的是阿片类药物，其与阿片类镇痛药消耗的边际显著增加相关（p=0.06）。
我们的初步数据表明，药物使用可能会显著改变创伤后急性疼痛管理，与非使用者相比，阿片类镇痛药的使用增加了 40%。由于创伤人群中物质使用的高患病率，这些结果可能具有广泛的影响。
