Patterns, Variation and Mental Health Impact of Opioid Prescribing after Burn Injury

Burn injury is a severe trauma that can cause debilitating pain, disability and declines in mental health and overall quality of life. Opioids are the mainstay therapy for management of pain after burn injury. In light of the opioid epidemic in the United States and the increased risk of harm associated with use of opioids, we sought to explore the trends, predictors, and impact on mental health of opioid prescribing after burn trauma, using a national commercial insurance database. First, we assessed the trends in opioid prescribing after burn injury in the outpatient setting and explored age, severity, and geographical variation. We found that opioid prescribing declined significantly between 2007 and 2017, however the rates of decline varied significantly among age groups, regions, and injury severity, with patients > 50, the South, and those with more severe burn realizing the least reductions in opioid prescriptions over time. Second, we assessed the rate of prescribing of gabapentinoids, alone or with opioids, over time to determine whether they were used as substitutes for opioid therapy. We found that gabapentinoid prescriptions alone increased significantly between 2012-2018, particularly among those over 50 years old, those residing in the South and the patients with less severe burns. Co-prescriptions with opioids did not differ significantly over time, after adjustment. Finally, we assessed the impact of opioid use on new onset depression, generalized anxiety or post-traumatic stress disorder in the post-burn period. We found that opioid prescribing after burn did not increase the risk for any mental health disorders, however those receiving opioids before burn were significantly more at risk to present with mood or stress disorders afterwards. Our findings support the need for uniform guidelines for the management of burn pain that promote non-opioid alternatives, as well as regular and timely screening for mental health problems in survivors of severe burn injury.

Name thesis:degree_name

Rehabilitation Science

Grantor

The University of Texas Medical Branch at Galveston

Year dc:date.issued

2021

Author dc:creator

• Polychronopoulou, Efstathia

• Health Sciences, Epidemiology
• Health Sciences, Public Health
• Health Sciences, Mental Health

Handle dc:identifier.uri

https://hdl.handle.net/2152.3/12485

OAI identifier oai:identifier

oai:utmb-ir.tdl.org:2152.3/12485