Injuries are frequently painful, and therefore require pain treatment. If the treatment is an opioid, how long will patients need the medication? This question is relevant, given the potential harms of long-term opioid treatment. This article does not deal with the controversial topic of whether and in which circumstances opioids should be prescribed for chronic pain. It rather focuses on the potential concern that an injury, such as a fracture or a burn, would result in long-term opioid use.
Data indicate that initiating opioid treatment in patients with acute pain, such as pain after a surgery or an injury, may increase the risk of long-term opioid use. Patients are discharged from the Emergency Department, Urgent Care, or after hospitalization with an opioid prescription for a limited number of days, but some of them will continue to use opioids in the long term. There is some evidence that higher opioid doses and longer use of opioids during episodes of acute pain are associated with higher probability of long-term use (see here). To date, the benefits of long-term opioid use after an injury are unclear, while concerns on potential harms remain. A recent study showed that patients with trauma who receive opioids in the emergency department have an increased likelihood of opioid use within three months after discharge, either as non-medical use or prescription.
Some good news ...
The question whether an injury may result in long-term opioid use has been address by our recent study, which was conducted by investigators of the University of Washington, Harborview Injury Prevention and Research Center (HIPRC). The study included 191,130 patients, 5,822 of which ended up having long-term opioid use. Only 3% of patients were prescribed opioids in the long term. While this low rate could be due to the fact that most injuries were minor, one could expect that suffering of major injuries would lead to higher use of opioids in the long term. However, the severity of the injury did not differ between patients with and without long-term opioid prescription. Another recent large study found that only 5.3% of patients with trauma used opioids after 3 months.
In our study, long-term opioid prescription was largely associated with prescription of opioids before the injury, mental health issues, and substance use disorder. The study did not assess opioid prescription for the injury as risk factor, but based on previous studies there is a positive association between opioid prescription for the acute injury and long-term use.
Take-home messages
Only very few patients with an injury continue to use opioids in the long term.
Chronic opioid use does not seem to be related to injury severity.
Long-term opioid use is primarily related to pain management and morbidities that precede the injury.
Based on previous studies, opioid prescription for the treatment of acute trauma many be associated with long-term opioid use. Therefore, responsible opioid prescription for an acute injury, with consideration of patient specific needs and risk factors, tapering plan and follow-up remain mandatory.