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US national trends in prescription opioid use after burn injury, 2007 to 2017

  • Efstathia Polychronopoulou
    Affiliations
    Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX

    Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
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  • Mukaila A. Raji
    Affiliations
    Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX

    Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch, Galveston, TX

    Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
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  • Steven E. Wolf
    Affiliations
    Division of Burn and Trauma Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX
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  • Yong-Fang Kuo
    Correspondence
    Reprint requests: Yong-Fang Kuo, PhD, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX.
    Affiliations
    Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX

    Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch, Galveston, TX

    Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX

    Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX
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Published:January 17, 2021DOI:https://doi.org/10.1016/j.surg.2020.12.011

      Abstract

      Background

      Opioid misuse and overdose in the United States remain a public health emergency. Overprescribing has been recognized as a significant contributor to the epidemic. Opioids are the mainstay for pain management after burn; however, to date, no large-scale nationally representative study has evaluated outpatient opioid prescribing practices in this population.

      Methods

      A retrospective study was conducted of patients up to 65 years old with burn injuries between 2007 and 2017 using national commercial insurance data. The primary outcome was initial opioid prescribing after burn injury. Secondary outcomes were total days’ supply, oral daily morphine milligram equivalents, and number of refills.

      Results

      Of the 140,753 patients with burns, 34,685 (24.6%) received an opioid prescription. The odds of prescription opioid use were lower in 2015, 2016, and 2017 compared with 2007. Interactions with age, severity (P < .0001), and region (P = .003) showed significant variation in rates of decline from 2007 to 2017, with the steepest decline in those aged <20 and in residents of Northeast United States. Prescribing rates remained stable over time among those with more severe burn injuries. The significant decline in daily opioid morphine milligram equivalents after 2013 was paralleled by an increase in days of supply (P values <.005). The odds of refill declined in 2016 and 2017.

      Conclusion

      While opioid prescribing after burn has declined in the past decade, significant variation remains among regions and age groups, suggesting a need to develop uniform guidelines to improve the quality of opioid prescribing and pain management protocols in burn patients.
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