title: Postdischarge nonmedical use of prescription opioids in at-risk drinkers admitted to urban level I trauma centers.
abstract: BACKGROUND
  Nonmedical use of prescription opioids (NM-POs) has reached epidemic proportions in the United States. Unintentional overdose deaths involving prescription opioids have quadrupled since 1999. Herein, we examine NM-POs and their associated risk factors among two cohorts of trauma patients with at-risk drinking.
  
  
  METHODS
  This secondary analysis examines NM-PO from two separate randomized trials that delivered brief alcohol interventions to patients in urban Level I trauma centers. In the first study, data were collected from 1,493 injured patients at a single trauma center, and in the second study, data were collected from 596 injured patients at two trauma centers. All participants were considered at-risk drinkers because they were admitted for an alcohol related injury as indicated by a positive blood alcohol concentration and/or self-reported heavy drinking.
  
  
  RESULTS
  In Study 1, NM-PO nearly doubled from 5.2% before admission to 9.8% at 6 months after discharge. At 12 months after discharge, those who reported NM-PO (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.28-4.15) and drug use (OR, 2.62, 95% CI, 1.70-4.04) before admission had the highest odds for postdischarge NM-PO. In Study 2, NM-PO increased from 5.2% before admission to 6.8% at 12 months after discharge. At 12 months after discharge, those who reported NM-PO (OR, 2.71; 95% CI, 1.10-6.66) or drug use (OR, 4.05; 95% CI, 2.00-8.21) before admission had the highest odds for postdischarge NM-PO.
  
  
  CONCLUSIONS
  The results suggest that there is an increased risk of postdischarge NM-PO among injured patients with at-risk drinking, particularly among those with a recent history of drug use or NM-PO. Cautious, evidence-based opioid prescribing may reduce exposure to prescription opioids in high-risk patients, risk of subsequent misuse, and possible diversion.
  
  
  METHODS
  Prognostic/epidemiologic study, level II.
authors.affiliation: From the University of Texas at Austin (C.A.F.); and University Medical Center at Brackenridge (C.V.R.B.), Austin; and University of Texas School of Public Health and University of Texas Southwestern Medical Center (R.C.); and Baylor University Medical Center (M.F.), Dallas, Texas; University of Pittsburgh (G.C.), Pittsburgh, Pennsylvania.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Field
authors.forename: Gerald
authors.initials: G
authors.lastname: Cochran
authors.forename: Raul
authors.initials: R
authors.lastname: Caetano
authors.forename: Michael
authors.initials: M
authors.lastname: Foreman
authors.forename: Carlos V R
authors.initials: CV
authors.lastname: Brown
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000517:prevention & control / Q000523:psychology; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D062405:Motivational Interviewing; D010351:Patient Discharge / Q000706:statistics & numerical data; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D012307:Risk Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid