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Opioid Poisoning and Opioid Use Disorder in Older Trauma Patients

BACKGROUND: Patients hospitalized following a traumatic injury will be frequently treated with opioids during their stay and after discharge. We examined the relationship between acute phase (<3 months) opioid use after discharge and the risk of opioid poisoning or use disorder in older trauma pa...

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Autores principales: Daoust, Raoul, Paquet, Jean, Moore, Lynne, Cournoyer, Alexis, Émond, Marcel, Gosselin, Sophie, Lavigne, Gilles J, Boulanger, Aline, Mac-Thiong, Jean-Marc, Chauny, Jean-Marc
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266327/
https://www.ncbi.nlm.nih.gov/pubmed/32546994
http://dx.doi.org/10.2147/CIA.S252849
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author Daoust, Raoul
Paquet, Jean
Moore, Lynne
Cournoyer, Alexis
Émond, Marcel
Gosselin, Sophie
Lavigne, Gilles J
Boulanger, Aline
Mac-Thiong, Jean-Marc
Chauny, Jean-Marc
author_facet Daoust, Raoul
Paquet, Jean
Moore, Lynne
Cournoyer, Alexis
Émond, Marcel
Gosselin, Sophie
Lavigne, Gilles J
Boulanger, Aline
Mac-Thiong, Jean-Marc
Chauny, Jean-Marc
author_sort Daoust, Raoul
collection PubMed
description BACKGROUND: Patients hospitalized following a traumatic injury will be frequently treated with opioids during their stay and after discharge. We examined the relationship between acute phase (<3 months) opioid use after discharge and the risk of opioid poisoning or use disorder in older trauma patients. METHODS: In a retrospective multicenter cohort study conducted on registry data, we included all patients ≥65 years admitted (hospital stay >2 days) for injury in 57 trauma centers in the province of Quebec (Canada) between 2004 and 2014. We searched for opioid poisoning and opioid use disorder from ICD-9 to ICD-10 code diagnosis after their initial injury. Patients that filled an opioid prescription within a 3-month period after sustaining the trauma were compared to those who did not, using Cox proportional hazards regressions. RESULTS: A total of 70,314 admissions were retained for analysis; median age was 82 years (IQR: 75–87), 68% were women, and 34% of the patients filled an opioid prescription within 3 months of the initial trauma. During a median follow-up of 2.6 years (IQR: 1–5), 192 participants (0.27%; 95% CI: 0.23%-0.31%) were hospitalized for opioid poisoning and 73 (0.10%; 95% CI: 0.08%-0.13%) were diagnosed with opioid use disorder. Having filled an opioid prescription within 3 months of injury was associated with an increased hazard ratio of opioid poisoning (2.8; 95% CI: 2.1–3.8) and opioid use disorder (4.2; 95% CI: 2.4–7.4) after the injury. However, history of opioid poisoning (2.6; 95% CI: 1.1–5.8), of substance use disorder (4.3; 95% CI: 2.4–7.7), or of the opioid prescription filled (2.8; 95% CI: 2.2–3.6) before the trauma, was also related to opioid poisoning or opioid use disorder after the injury. CONCLUSION: Opioid poisoning and opioid use disorder are rare events after hospitalization for trauma in older patients. However, opioids should be used cautiously in patients with a history of substance use disorder, opioid poisoning or opioid use.
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spelling pubmed-72663272020-06-15 Opioid Poisoning and Opioid Use Disorder in Older Trauma Patients Daoust, Raoul Paquet, Jean Moore, Lynne Cournoyer, Alexis Émond, Marcel Gosselin, Sophie Lavigne, Gilles J Boulanger, Aline Mac-Thiong, Jean-Marc Chauny, Jean-Marc Clin Interv Aging Original Research BACKGROUND: Patients hospitalized following a traumatic injury will be frequently treated with opioids during their stay and after discharge. We examined the relationship between acute phase (<3 months) opioid use after discharge and the risk of opioid poisoning or use disorder in older trauma patients. METHODS: In a retrospective multicenter cohort study conducted on registry data, we included all patients ≥65 years admitted (hospital stay >2 days) for injury in 57 trauma centers in the province of Quebec (Canada) between 2004 and 2014. We searched for opioid poisoning and opioid use disorder from ICD-9 to ICD-10 code diagnosis after their initial injury. Patients that filled an opioid prescription within a 3-month period after sustaining the trauma were compared to those who did not, using Cox proportional hazards regressions. RESULTS: A total of 70,314 admissions were retained for analysis; median age was 82 years (IQR: 75–87), 68% were women, and 34% of the patients filled an opioid prescription within 3 months of the initial trauma. During a median follow-up of 2.6 years (IQR: 1–5), 192 participants (0.27%; 95% CI: 0.23%-0.31%) were hospitalized for opioid poisoning and 73 (0.10%; 95% CI: 0.08%-0.13%) were diagnosed with opioid use disorder. Having filled an opioid prescription within 3 months of injury was associated with an increased hazard ratio of opioid poisoning (2.8; 95% CI: 2.1–3.8) and opioid use disorder (4.2; 95% CI: 2.4–7.4) after the injury. However, history of opioid poisoning (2.6; 95% CI: 1.1–5.8), of substance use disorder (4.3; 95% CI: 2.4–7.7), or of the opioid prescription filled (2.8; 95% CI: 2.2–3.6) before the trauma, was also related to opioid poisoning or opioid use disorder after the injury. CONCLUSION: Opioid poisoning and opioid use disorder are rare events after hospitalization for trauma in older patients. However, opioids should be used cautiously in patients with a history of substance use disorder, opioid poisoning or opioid use. Dove 2020-05-27 /pmc/articles/PMC7266327/ /pubmed/32546994 http://dx.doi.org/10.2147/CIA.S252849 Text en © 2020 Daoust et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Daoust, Raoul
Paquet, Jean
Moore, Lynne
Cournoyer, Alexis
Émond, Marcel
Gosselin, Sophie
Lavigne, Gilles J
Boulanger, Aline
Mac-Thiong, Jean-Marc
Chauny, Jean-Marc
Opioid Poisoning and Opioid Use Disorder in Older Trauma Patients
title Opioid Poisoning and Opioid Use Disorder in Older Trauma Patients
title_full Opioid Poisoning and Opioid Use Disorder in Older Trauma Patients
title_fullStr Opioid Poisoning and Opioid Use Disorder in Older Trauma Patients
title_full_unstemmed Opioid Poisoning and Opioid Use Disorder in Older Trauma Patients
title_short Opioid Poisoning and Opioid Use Disorder in Older Trauma Patients
title_sort opioid poisoning and opioid use disorder in older trauma patients
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266327/
https://www.ncbi.nlm.nih.gov/pubmed/32546994
http://dx.doi.org/10.2147/CIA.S252849
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