Department of Surgery, University of Utah, School of Medicine, Salt Lake City, UT 84121.
Intermountain Primary Children's Hospital, Salt Lake City, UT 84113.
Ann Surg. 2022 Dec 1;276(6):e955-e960. doi: 10.1097/SLA.0000000000004769. Epub 2021 Jan 22.
This study aims to determine if outpatient opioid prescriptions are associated with future SUD diagnoses and overdose in injured adolescents 5 years following hospital discharge.
Approximately, 1 in 8 adolescents are diagnosed with an SUD and 1 in 10 experience an overdose in the 5 years following injury. State laws have become more restrictive on opioid prescribing by acute care providers for treating pain, however, prescriptions from other outpatient providers are still often obtained.
This was a retrospective cohort study of patients ages 12-18 admitted to 2 level I trauma centers. Demographic and clinical data contained in trauma registries were linked to a regional database containing 5 years of electronic health records and prescription data. Regression models assessed whether number of outpatient opioid prescription fills after discharge at different time points in recovery were associated with a new SUD diagnosis or overdose, while controlling for demographic and injury characteristics, and depression and posttraumatic stress disorder diagnoses.
We linked 669 patients (90.9%) from trauma registries to a regional health information exchange database. Each prescription opioid refill in the first 3 months after discharge increased the likelihood of new SUD diagnoses by 55% (odds ratio: 1.55, confidence interval: 1.04-2.32). Odds of overdose increased with ongoing opioid use over 2-4 years post-discharge ( P = 0.016-0.025).
Short-term outpatient opioid prescribing over the first few months of recovery had the largest effect on developing an SUD, while long-term prescription use over multiple years was associated with a future overdose.
本研究旨在确定门诊阿片类药物处方是否与青少年出院后 5 年内未来的物质使用障碍（SUD）诊断和药物过量有关。
大约有 1/8 的青少年被诊断出患有 SUD，有 1/10 的青少年在受伤后 5 年内经历药物过量。州法律对急性护理提供者开具阿片类药物治疗疼痛的处方变得更加严格，但其他门诊提供者的处方仍经常开具。
这是一项回顾性队列研究，纳入了在 2 家一级创伤中心就诊的年龄在 12-18 岁的患者。创伤登记册中包含的人口统计学和临床数据与包含 5 年电子健康记录和处方数据的区域数据库相关联。回归模型评估了在恢复过程中不同时间点出院后开出的门诊阿片类药物处方数量与新的 SUD 诊断或药物过量之间的关系，同时控制了人口统计学和损伤特征以及抑郁和创伤后应激障碍的诊断。
我们将创伤登记册中的 669 名患者（90.9%）与区域健康信息交换数据库相关联。出院后前 3 个月的每次阿片类药物处方补充都使新的 SUD 诊断的可能性增加了 55%（比值比：1.55，置信区间：1.04-2.32）。出院后 2-4 年内持续使用阿片类药物与药物过量的可能性增加相关（P = 0.016-0.025）。
恢复最初几个月的短期门诊阿片类药物处方对 SUD 的发展影响最大，而多年多次处方使用与未来的药物过量有关。
