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 ( 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.