Population-based multistate modelling of peritraumatic opioid use among trauma patients from the Norwegian Trauma Registry.

Abstract

Previous studies document high rates of long-term opioid use (LTU) among trauma patients, without accounting for opioid prescription doses, frequency, and medical indications. Using detailed LTU criteria, this study aimed to construct a multistate model of peritraumatic opioid use and elucidate reasons for posttraumatic LTU. This population-based cohort study links data from the 2015-2018 cohorts in the Norwegian Trauma Registry (n=24 224) with outpatient medication prescription records from the Norwegian Prescription Database for 1 yr before and 2 yr after injury. LTU was assigned upon receiving ≥900 morphine milligram equivalents within 90 days and another opioid prescription 91-180 days after any initial prescription; it ended after 180 days without opioid prescriptions, emigration, or death. Prescriptions to patients with LTU in the year after injury were screened for chronic pain and palliative care reimbursement codes, and for opioid maintenance treatment preparations. Posttraumatic opioid prescriptions primarily increased as a result of short-term opioid use (STU), peaking at 38.2% and returning to pre-injury levels (5.4%) within 6 months. Increases in LTU were smaller (4.3% to 6.7%). Among patients with LTU in the year after injury (n=1946), 47.4% exhibited LTU and 18.3% STU in the 6 months pre-injury. Moreover, 36.0% were reimbursed for chronic pain medications, 5.9% for palliative care, and 13.1% received opioid maintenance treatment. In our cohort, most patients with posttraumatic long-term opioid use had used opioids before injury, underscoring the need to address such use to minimise posttraumatic long-term opioid use. Few patients with long-term opioid use received palliative care or opioid maintenance treatment, indicating subacute and chronic pain as primary indications. As long-term opioid use for pain is highly controversial, findings emphasise a need for effective nonopioid alternatives.