Long-Term Prescription Opioid Use After Injury in Washington State 2015-2018

J Emerg Med. 2022 Aug;63(2):178-191. doi: 10.1016/j.jemermed.2022.04.029. Epub 2022 Aug 26.


Background: Patients with injury may be at high risk of long-term opioid use due to the specific features of injury (e.g., injury severity), as well as patient, treatment, and provider characteristics that may influence their injury-related pain management.

Objectives: Inform prescribing practices and identify high-risk populations through studying chronic prescription opioid use in the trauma population.

Methods: Using the Washington State All-Payer Claims Database (WA-APCD) data, we included adults aged 18-65 years with an incident injury from October 1, 2015-December 31, 2017. We compared patient, injury, treatment, and provider characteristics by whether or not the patients had long-term (≥ 90 days continuous prescription opioid use), or no opioid use after injury.

Results: We identified 191,130 patients who met eligibility criteria and were included in our cohort; 5822 met criteria for long-term use. Most had minor injuries, with a median Injury Severity Score = 1, with no difference between groups. Almost all patients with long-term opioid use had filled an opioid prescription in the year prior to their injury (95.3%), vs. 31.3% in the no-use group (p < 0.001). Comorbidities associated with chronic pain, mental health, and substance use conditions were more common in the long-term than the no-use group.

Conclusion: Across this large cohort of multiple, mostly minor, injury types, long-term opioid use was relatively uncommon, but almost all patients with chronic use post injury had preinjury opioid use. Long-term opioid use after injury may be more closely tied to preinjury chronic pain and pain management than acute care pain management.

Keywords: chronic pain; chronic use; injury; opioids; persistent use.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Analgesics, Opioid / adverse effects
  • Chronic Pain* / drug therapy
  • Chronic Pain* / epidemiology
  • Chronic Pain* / etiology
  • Drug Prescriptions
  • Humans
  • Opioid-Related Disorders* / epidemiology
  • Practice Patterns, Physicians'
  • Retrospective Studies
  • Washington / epidemiology


  • Analgesics, Opioid