Personality, High-Risk Behaviors, and Elevated Risk of Unintentional Deaths Related to Drug Poisoning Among Individuals With Spinal Cord Injury

Relations Between Self-Reported Prescription Hydrocodone, Oxycodone, and Tramadol Use and Unintentional Injuries Among Those With Spinal Cord Injury

OBJECTIVE

To identify the relations of 3 frequently used prescription opioids (hydrocodone, oxycodone, tramadol) with unintentional injuries, including fall-related and non-fall-related injuries among adults with chronic, traumatic spinal cord injury (SCI).

DESIGN

Cross-sectional cohort study.

SETTING

Community setting; Southeastern United States.

PARTICIPANTS

Adult participants (N=918) with chronic traumatic SCI were identified from a specialty hospital and state population-based registry and completed a self-report assessment.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Self-reported fall-related and non-fall-related unintentional injuries serious enough to receive medical care in a clinic, emergency room, or hospital within the previous 12 months.

RESULTS

Just over 20% of participants reported ≥1 unintentional injury in the past year, with an average of 2.16 among those with ≥1. Overall, 9.6% reported fall-related injuries. Only hydrocodone was associated with any past-year unintentional injuries. Hydrocodone taken occasionally (no more than monthly) or regularly (weekly or daily) was related to 2.63 (95% confidence interval [CI], 1.52-4.56) or 2.03 (95% CI, 1.15-3.60) greater odds of having ≥1 unintentional injury in the past year, respectively. Hydrocodone taken occasionally was also associated with past-year non-fall-related injuries (OR, 2.20; 95% CI, 1.12-4.31). Each of the 3 opioids was significantly related to fall-related injuries. Taking hydrocodone occasionally was associated with 2.39 greater odds of fall-related injuries, and regular use was associated with 2.31 greater odds. Regular use of oxycodone was associated with 2.44 odds of a fall-related injury (95% CI, 1.20-4.98), and regular use of tramadol was associated with 2.59 greater odds of fall-related injury (95% CI, 1.13-5.90).

CONCLUSIONS

Injury prevention efforts must consider the potential effect of opioid use, particularly hydrocodone. For preventing fall-related injuries, each of the 3 opioids must be considered.

Self-Reported Prescription Opioid Use Among Participants with Chronic Spinal Cord Injury

Background

Individuals with spinal cord injuries (SCI) experience high rates of prescription opioid use, yet there is limited data on frequency of opioid use and specific medications being taken.

Objectives

To examine the frequency of self-reported prescription opioid use among participants with SCI and the relationship with demographic, injury, and socioeconomic characteristics.

Methods

A cohort study of 918 adults with SCI of at least 1-year duration completed a self-report assessment (SRA) that indicated frequency of specific prescription opioid use based on the National Survey on Drug Use and Health (NSDUH).

Results

Forty-seven percent of the participants used at least one prescription opioid over the last year; the most frequently used was hydrocodone (22.1%). Nearly 30% used a minimum of one opioid at least weekly. Lower odds of use of at least one opioid over the past year was observed for Veterans (odds ratio [OR] = 0.60, 95% CI = 0.38, 0.96) and those with a bachelor's degree or higher (OR = 0.63, 95% CI = 0.44, 0.91). When restricting the analysis to use of at least one substance daily or weekly, lower odds of use was observed for those with a bachelor's degree or higher and those with income ranging from $25,000 to $75,000+. None of the demographic or SCI variables were significantly related to prescription opioid use.

Conclusion

Despite the widely established risks, prescription opioids were used daily or weekly by more than 28% of the participants. Usage was only related to Veteran status and socioeconomic status indicators, which were protective of use. Alternative treatments are needed for those with the heaviest, most regular usage.

Spinal cord injury and prescribed opioids for pain: a scoping review

OBJECTIVE

Spinal cord injury (SCI) is a life-altering neurological condition affecting physical and psycho-social functioning and associated high rates of pain. Thus, individuals with SCI may be more likely to be exposed to prescription opioids. A scoping review was conducted to synthesize published research findings on post-acute SCI and prescription opioid use for pain, identify literature gaps, and propose recommendations for future research.

METHODS

We searched 6 electronic bibliographic databases (PubMed [MEDLINE], Ovid [MEDLINE], EMBASE, Cochrane Library, CINAHL, PsychNET) for articles published from 2014 through 2021. Terms for "spinal cord injury" and "prescription opioid use" were used. Included articles were in English and peer reviewed. Data were extracted using an electronic database by 2 independent reviewers. Opioid use risk factors for chronic SCI were identified and a gap analysis was performed.

RESULTS

Of the 16 articles included in the scoping review, a majority were conducted in the United States (n = 9). Most articles lacked information on income (87.5%), ethnicity (87.5%), and race (75%). Prescription opioid use ranged from 35% to 64% in articles reporting this information (n = 7 articles, n = 3675 participants). Identified risk factors for opioid use included middle age, lower income, osteoarthritis diagnosis, prior opioid use, and lower-level spinal injury. Limited reporting of diversity in study populations, absence of risk of polypharmacy, and limited high quality methodology were identified gaps.

CONCLUSIONS

Future research should report data on prescription opioid use in SCI populations, with additional demographics such as race, ethnicity, and income, given their importance to risk outcomes.

Trends in hospital admission related to poisoning by, narcotics and psychodysleptics and poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs in England and Wales between April 1999 and April 2020: An ecological study

Background

This study aimed to investigate the trend of hospital admissions related to poisoning by narcotics and psychodysleptics and poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs in England and Wales between April 1999 and April 2020.

Methods

An observational ecological study were conducted using data from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. The rate of hospital admissions with 95% confidence intervals (CIs) was calculated by dividing the number of episodes of poisoning by narcotics and psychodysleptics related admission and poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs-related admission by the mid-year population from the Office for National Statistics. All analyses were conducted using SPSS version 27.

Results

The total annual number of hospital admissions for narcotics and psychodysfunctionals poisonings increased by 1.40-fold [from 15.70 (95% CI 15.36-16.04) in 1999 to 37.64 (95% CI 37.15-38.13) in 2020 per 100,000 people, p < 0.01]. However, the overall annual number of poisonings by antiepileptic, sedative-hypnotic and antiparkinsonism drugs hospital admissions for various reasons decreased by 12.8% [from 33.55 (95% CI 33.05-34.04) in 1999 to 29.26 (95% CI 28.82-29.69) in 2020 per 100,000 persons, p < 0.05]. Poisoning by other opioids (53.2%), heroin (15.1%), and other synthetic narcotics (13.3%) were the most common reasons for narcotic and psychodysfunctional poisoning. While poisoning by benzodiazepines (54.2%) and poisoning: other antiepileptic and sedative-hypnotic drugs (30.7%) were the most common hospital admission reasons for poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism.

Conclusion

Poisoning by narcotics have increased in England and Wales over the study period, however, poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs in England and Wales were relatively stable during the same period. Future initiatives and awareness programs to prevent harmful use and drug poisoning by narcotics, sedative-hypnotic and other medications are needed.

Opioid Dependence and Associated Health Care Utilization and Cost in Traumatic Spinal Cord Injury Population: Analysis Using Marketscan Database

Background

Postinjury pain is a well-known debilitating complication of spinal cord injury (SCI), often resulting in long-term, high-dose opioid use with the potential for dependence. There is a gap in knowledge about the risk of opioid dependence and the associated health care utilization and cost in SCI.

Objectives

To evaluate the association of SCI with postinjury opioid use and dependence and evaluate the effect of this opioid dependence on postinjury health care utilization.

Methods

Using the MarketScan Database, health care utilization claims data were queried to extract 7187 adults with traumatic SCI from 2000 to 2019. Factors associated with post-SCI opioid use and dependence, postinjury health care utilization, and payments were analyzed with generalized linear regression models.

Results

After SCI, individuals were more likely to become opioid users or transition from nondependent to dependent users (negative change: 31%) than become nonusers or transition from dependent to nondependent users (positive change: 14%, p < .0001). Individuals who were opioid-dependent users pre-SCI had more than 30 times greater odds of becoming dependent after versus not (OR 34; 95% CI, 26-43). Dependent users after injury (regardless of prior use status) had 2 times higher utilization payments and 1.2 to 6 times more health care utilization than nonusers.

Conclusion

Opioid use and dependence were associated with high health care utilization and cost after SCI. Pre-SCI opioid users were more likely to remain users post-SCI and were heavier consumers of health care. Pre- and postopioid use history should be considered for treatment decision-making in all individuals with SCI.

The trend of top five types of poisonings in hospitalized patients based on ICD‐10 in the northeast of Iran during 2012–2018: A cross‐sectional study

Background and Aims

Poisoning remains a major health issue in developing countries with high morbidity and mortality rates; also it is one of the most common causes of admission to hospitals. This study aimed to investigate the trend of the top five types of poisonings in hospitalized patients according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD‐10) in Imam Reza hospital, Mashhad, Iran.

Methods

This was a cross‐sectional study performed from March 20, 2012, until September 22, 2018. We collected data from all patients hospitalized for poisoning admitted to the poisoning center at Imam Reza hospital in northeast Iran. ICD‐10 was adopted to categorize all types of poisonings (T36‐T65). The results obtained were analyzed by SPSS 16.

Results

Thirty‐four thousand eight hundred and ten cases were included. The mean age of the patients was 29.64 ± 14.69 years, of them, 50.7% were males. Benzodiazepine poisoning (T42.4) has the highest frequency among other subcategories and it was more common among females (60.5%). Opium poisoning (T40.0) has the highest mortality rate (5.4%) among other subcategories that is more common in males (72.0%). The mortality associated with narcotics was the highest frequency (2.7%). Suicide (83.6%) was the most common cause of poisoning. Most poisonings occurred in summer (27.4%).

Conclusion

These findings could help health care managers and policymakers develop prevention and educational programs to reduce these poisonings and limit people's easy access to drugs and substances.

Implications of the Opioid Crisis for the American Disability Community

Purpose

The profession of rehabilitation counseling has long been responsive to emerging disabilities. To date, however, the profession's attention and response to the ongoing opioid crisis in the United States has been incommensurate with the scope and detriment of opioids and opioid use disorder (OUD) on Americans with disabilities. The opioid crisis, including the overuse, abuse, and overdose rates associated with prescription and illegal opioids, affects people of all ages and backgrounds. However, people with disabilities are at increased risk for developing OUDs, and they experience greater barriers to OUD treatment than people without disabilities.

Method

This article describes the origins and development of this crisis, the relationship between disability and increased risk for OUD, and the barriers to treatment that exist. We then evaluate the role of rehabilitation counseling, including the need for further action in advocacy, research, education, and policy.

Results and Conclusions

Throughout this article, we encourage a more urgent and concerted response than seems to be the case presently.

Opioid Use Among Individuals With Spinal Cord Injury: Prevalence Estimates Based on State Prescription Drug Monitoring Program Data

OBJECTIVE

To identify the prevalence of opioid use in individuals with chronic spinal cord injury (SCI) living in South Carolina.

DESIGN

Cohort study.

SETTING

Data from 2 statewide population-based databases, an SCI Registry and the state prescription drug monitoring program, were linked and analyzed.

PARTICIPANTS

The study included individuals (N=503) with chronic (>1y) SCI who were injured between 2013 and 2014 in South Carolina and who survived at least 3 years postinjury.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Filled opioid prescriptions over a 2-year period (months 13-36 after injury). The main outcomes were total number of days with an opioid prescription over the 2-year period, length of coverage period [(final day of prescription coverage+the days supplied)-first day of prescription coverage], average daily morphine milligram equivalents (MME) over the coverage period, and concurrent days covered by an opioid and a prescription for benzodiazepines, sedatives, or hypnotics.

RESULTS

A total of 53.5% of the cohort (269 individuals) filled at least 1 opioid prescription during their second or third year after SCI. In total, there were 3386 opioid fills during the 2-year study. On average, the total number of opioid prescription days was 293±367. The average coverage period was 389±290 days, and the average daily MME during the coverage period was 41±70 MME. Of those who filled an opioid prescription, 23% had high-risk fills (>50 MME), and 38% had concurrent prescriptions for benzodiazepines, sedatives, or hypnotics.

CONCLUSIONS

The prevalence of opioid use was high among individuals with chronic SCI, exceeding rates observed in the general population. Also concerning were the rates of high-risk fills, based on average daily MME and concurrent benzodiazepine, sedative, or hypnotic prescriptions. These findings, taken together with those of earlier studies, should be used by providers to assess and monitor opioid use, decrease concurrent high-risk medication use, and attenuate the risk of adverse outcomes.

Psychological factors and risk of mortality after spinal cord injury

Objective: Identify the association of personality and purpose in life with competing risks of multiple causes of death after spinal cord injury (SCI), using data from the SCI Longitudinal Health Study. Design: Prospective cohort study with data collected in 1997-1998 and 2007-2009. Mortality status determined as of December 31, 2016. Setting: Specialty hospital in the Southeastern United States. Participants: 3070 adults with chronic (>1-year), traumatic SCI. Interventions: N/A. Outcome Measures: We examined 6 psychological factors (Purpose in Life and 5 scales of the Zuckerman-Kuhlman Personality Questionnaire) and risk of mortality due to 6 specific causes of death, building on published analyses of behavioral and health/clinical risk and protective factors. Results: There were 803 deaths. Four of the 6 psychological factors were predictive of all-cause mortality. All except 1 personality scale were related to cause-specific mortality. Psychological factors were most predictive of unintentional injury deaths. Purpose in life was protective of death due to pneumonia; whereas, Activity was protective of death due to diseases of heart and blood vessels and to unintentional injury. Sociability, Impulsive-Sensation Seeking, and Neuroticism-Anxiety were risk factors for death due to unintentional injury. Neuroticism-Anxiety was related to death due to septicemia. There were no significant psychological predictors of cancer. Conclusions: Rehabilitation professionals have a central role in promoting purpose in life as a means of increasing longevity. By assessing personality factors predictive of specific causes of mortality, those at risk may be targeted for cause-specific prevention strategies.

Health factors and spinal cord injury: a prospective study of risk of cause-specific mortality

STUDY DESIGN

Prospective cohort study.

OBJECTIVES

Identify the risk and protective factors of all-cause and cause-specific mortality among persons with traumatic spinal cord injury (SCI).

SETTING

Rehabilitation specialty hospital in the Southeastern United States.

METHODS

A prospective cohort study was conducted with 3070 adults with traumatic SCI who were a minimum of 1 year post-injury at assessment. Prospective data were collected in 1997-1998 and 2007-2010, with mortality determined as of 31 December, 2016. The deceased were classified into six categories based on underlying cause of death: septicemia, pneumonia and influenza, cancer, heart and blood vessel diseases, unintentional injuries, and all other causes. The competing risk analysis strategy applied to each of the specific causes.

RESULTS

There were a total of 803 observed deaths among the 2979 final study sample. After controlling for demographic and injury characteristics, general health, pressure ulcer history, and symptoms of infections were significantly associated with all-cause mortality. Except for cancer, they were also related with at least one of the specific causes of death, whereas orthopedic complications and subsequent injuries were unrelated to any cause.

CONCLUSIONS

Three health domains, global health, pressure ulcers, and symptoms of illness or infection, were significantly associated with mortality after SCI, and the patterns of association varied as a function of specific cause of death.