Category: Brain Injury; Health Services Research; Military and Veterans Affairs
Objective : To investigate how individuals with traumatic brain injury (TBI) may be uniquely susceptible to opioid misuse and its consequences.
Design : Scoping review ofrisk factors for opioid use disorder (OUD) among people with TBI.
Setting : Studies of individuals with TBI from community-dwelling adults, inpatient rehabilitation, and the Military Health System (MHS).
Participants (or Animals, Specimens, Cadavers) :
Community dwelling adults 5-years post-TBI (Mid-life in the United States Study [MIDUS]), persons who received inpatient TBI-rehabilitation (e.g., TBI Model Systems [TBIMS]), and military members who received care in the MHS following deployment (Substance Use and Psychological Injury Combat Study [SUPIC]).
Interventions : Not applicable.
Main Outcome Measure(s) :
Chronic pain, receipt of prescription opioids, long-term opioid utilization.
Community-dwelling adults 5 years post-TBI reported higher age-adjusted rates of chronic pain compared to adults without a TBI. Men with TBI aged 40-49 reported more than twice the rate of chronic pain compared to adults without a TBI (60% versus 28%, respectively).Between 70-80% of patients with moderate-severe TBI were discharged from inpatient rehabilitation with prescription opioids. 58% of soldiers with a TBI diagnosis in the first 6 months postdeployment received an opioid prescription in the postdeployment year, compared to 35% among all soldiers returning from deployment. Soldiers with a TBI diagnosis had an increased likelihood of long-term opioid utilization.
The convergence of multiple risk factors among people with a history of TBI creates a perfect storm such that persons with TBI may be uniquely vulnerable to opioid misuse and its devastating consequences. We conclude with a research agenda to quantify and characterize the population of individuals with TBI and OUD, and to identify opportunities for prevention and tailored interventions.
Rachel Adams– Scientist, Brandeis University, Waltham, Massachusetts
John Corrigan– Professor, The Ohio State University, Columbus, Ohio
Kristen Dams-O'Connor– Associate Professor of Rehabilitation Medicine and Neurology; Director of Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, New York