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

James S Krause; Nicole D DiPiro; Clara E Dismuke-Greer; Yue Cao

doi:10.1016/j.apmr.2024.05.013

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

Arch Phys Med Rehabil. 2024 May 17:S0003-9993(24)01002-5. doi: 10.1016/j.apmr.2024.05.013. Online ahead of print.

Authors

James S Krause¹, Nicole D DiPiro², Clara E Dismuke-Greer³, Yue Cao²

Affiliations

¹ College of Health Professions, Medical University of South Carolina, Charleston, SC. Electronic address: krause@musc.edu.
² College of Health Professions, Medical University of South Carolina, Charleston, SC.
³ Health Economics Resource Center, Veterans Affairs Palo Alto, Menlo Park, CA.

PMID: 38762197
DOI: 10.1016/j.apmr.2024.05.013

Abstract

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.

Keywords: Accident prevention; Accidental falls; Accidents; Analgesics; Opioid; Rehabilitation; Spinal cord injuries.