Brittany E. Punches, Ohio State University
Uwe Stolz, University of Cincinnati
Caroline E. Freiermuth, University of Cincinnati
Rachel M. Ancona, Washington University School of Medicine
Samuel A. McLean, University of North Carolina at Chapel Hill
Stacey L. House, Washington University School of Medicine
Francesca L. Beaudoin, Alpert Medical School of Brown University
Xinming An, University of North Carolina at Chapel Hill
Jennifer S. Stevens, Emory University School of Medicine
Donglin Zeng, University of North Carolina
Thomas C. Neylan, University of California San Francisco
Gari D. Clifford, Emory University School of Medicine
Tanja Jovanovic, Wayne State University
Sarah D. Linnstaedt, University of North Carolina at Chapel Hill
Laura T. Germine, McLean Hospital
Kenneth A. Bollen, University of North Carolina at Chapel Hill
Scott L. Rauch, McLean Hospital
John P. Haran, University of Massachusetts Medical School
Alan B. Storrow, Vanderbilt University Medical Center
Christopher Lewandowski, Henry Ford Health System
Paul I. Musey Jr., Indiana University School of Medicine
Phyllis L. Hendry, University of Florida College of Medicine- Jacksonville
Sophia Sheikh, University of Florida College of Medicine- Jacksonville
Christopher W. Jones, Rowan University
Michael C. Kurz, University of Alabama School of Medicine
Nina T. Gentile, Temple University
Meghan E. McGrath, Boston Medical Center
Lauren A. Hudak, Emory University School of Medicine
Jose L. Pascual, University of Pennsylvania
Mark J. Seamon, University of Pennsylvania
Erica Harris, Thomas Jefferson UniversityFollow
Anna M. Chang, Thomas Jefferson University
Claire Pearson, Wayne State University
David A. Peak, Massachusetts General Hospital
Roland C. Merchant, Brigham and Women’s Hospital
Robert M. Domeier, Saint Joseph Mercy Hospital
Niels K. Rathlev, University of Massachusetts Medical School-Baystate
Brian J. O'Neil, Wayne State University
Leon D. Sanchez, Beth Israel Deaconess Medical Center
Steven E. Bruce, University of Missouri—St. Louis
Robert H. Pietrzak, Yale School of Medicine
Jutta Joormann, Yale School of Medicine
Deanna M. Barch, Washington University in St. Louis
Diego A. Pizzagalli, Harvard Medical School
Jordan W. Smoller, Massachusetts General Hospital
Beatriz Luna, University of Pittsburgh
Steven E. Harte, University of Michigan Medical School
James M. Elliott, University of Sydney
Ronald C. Kessler, Harvard Medical School
Kerry J. Ressler, Harvard Medical School
Karestan C. Koenen, Harvard University
Michael S. Lyons, University of Cincinnati, Cincinnati

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This article is the author's final published version in PLos One, Volume 17, Issue 9, Sept. 2022, Article number e0273378.

This published article is available online at Copyright © 2022 Punches et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


OBJECTIVE: Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use.

METHODS: Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed for euphoria) in the 30 days before enrollment, and missing or incomplete data regarding opioid exposure or pain. We used multivariable logistic regression to assess the relationship between ED opioid exposure and at-risk opioid use, defined as any self-reported non-medical opioid use after initial ED encounter or prescription opioid use at 3-months.

RESULTS: Of 1441 subjects completing 3-month follow-up, 872 participants were included for analysis. At-risk opioid use occurred within 3 months in 33/620 (5.3%, CI: 3.7,7.4) participants without ED opioid analgesic exposure; 4/16 (25.0%, CI: 8.3, 52.6) with ED opioid prescription only; 17/146 (11.6%, CI: 7.1, 18.3) with ED opioid administration only; 12/90 (13.3%, CI: 7.4, 22.5) with both. Controlling for clinical factors, adjusted odds ratios (aORs) for at-risk opioid use after ED opioid exposure were: ED prescription only: 4.9 (95% CI 1.4, 17.4); ED administration for analgesia only: 2.0 (CI 1.0, 3.8); both: 2.8 (CI 1.2, 6.5).

CONCLUSIONS: ED opioids were associated with subsequent at-risk opioid use within three months in a geographically diverse cohort of adult trauma patients. This supports need for prospective studies focused on the long-term consequences of ED opioid analgesic exposure to estimate individual risk and guide therapeutic decision-making.

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Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

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