The Impact of Intentionality of Injury and Substance Use History on Receipt of Discharge Opioid Medication in a Cohort o
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The Impact of Intentionality of Injury and Substance Use History on Receipt of Discharge Opioid Medication in a Cohort of Seriously Injured Black Men Shoshana V. Aronowitz 1 Therese S. Richmond 2
&
Sara F. Jacoby 2 & Peggy Compton 2 & Justine Shults 3 & Andrew Robinson 2 &
Received: 27 May 2020 / Revised: 7 October 2020 / Accepted: 9 October 2020 # W. Montague Cobb-NMA Health Institute 2020
Abstract Black patients are less likely than white patients to receive pain treatment, especially opioids, for both acute and chronic pain. Black men are at higher risk than other populations of being “assumed criminal” regardless of any involvement in criminal activity. Additionally, certain injury and patient characteristics such as intentionality of injury and substance use history may lead providers to suspect criminal involvement and impact pain treatment decisions. The purpose of this study was to describe factors that predict receipt of opioid prescription at hospital discharge. We conducted a secondary analysis of data from a cohort of 623 seriously injured Black men treated at trauma centers in Philadelphia between 2013 and 2017. Regression models were used to examine relationships between discharge opioid prescriptions, injury intent, and substance use history. Controlling for age, injury severity, pain score, length of hospital stay (LOS), insurance type, and year of study, receipt of opioids was not impacted by injury intent. However, patients who self-reported substance overuse were less likely to receive opioids than those who did not. Patients with higher injury severity, pain scores, and longer LOS were more likely to receive opioids. Of patients who received opioids, patients with higher pain scores and longer LOS received higher dosages than those with lower scores and shorter LOS. While previous research highlights stigmatization experienced by intentionally injured patients, injury intent did not impact receipt of discharge opioid prescriptions in this study. Future research should continue to explore the effect of injury intent on patients’ experiences in the healthcare system. Keywords Injury . Pain . Analgesia . Opioid
Introduction As emergency care for severely injured patients improves, more patients are surviving serious injuries and reentering the community [1, 2]. Many of these patients require ongoing pain management upon discharge from the hospital to
prevent the negative physical, mental, social, and financial outcomes associated with inadequately treated pain [3, 4]. At the same time, fears about potential for misuse or diversion of opioid analgesics have impacted clinical practice and providers have become more cautious and restrictive in their opioid prescribing [5, 6].
* Shoshana V. Aronowitz [email protected] Sara F. Jacoby [email protected]
Therese S. Richmond [email protected] 1
National Clinician Scholars Program, University of Pennsylvania, 13th Floor Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA
2
School of Nursing,
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