Community opioid dispensing prevalence and patterns in adults with spinal cord injury in Queensland: a retrospective data linkage study

Study design: Population-based data linkage of state-based opioid dispensing, hospital administrative and death registry data. Objective: This study aimed to provide a detailed overview of opioid dispensing in the 2-years following SCI. Setting: Community.Methods: Linked data were obtained for adults admitted to Queensland hospitals with a new traumatic or non-traumatic SCI from 1 January 2014 to 31 December 2017. Community opioid dispensing data was obtained for 3 months pre-SCI and up to two years after their Index Hospital Admission for SCI. Chronic dispensing (>90 cumulative dispensing days) and high end dose (median daily dose of 50 or more oral morphine equivalents in the last 3 months of dispensing) were calculated from dispensing data. Results: Of the 298 included cases (180 traumatic; 118 non-traumatic), 1 or more opioids were dispensed to 19% of the cohort in the 3 months pre-SCI (40% non-traumatic SCI; 6% traumatic SCI) and to 53% post-SCI (56% non-traumatic SCI; 52% traumatic SCI). Those who were dispensed opioids pre-SCI were 3.7 times more likely to have been dispensed opioids in the observation period (95% confidence interval: 1.90, 7.24, p<.001). Thirty percent of the cohort have been dispensed opioids chronically. High opioid end doses were significantly more likely among those with non-traumatic SCI. Conclusions: Whilst it was positive that many were not dispensed an opioid following their SCI, the high prevalence of high opioid doses and chronic duration is concerning. The reliance on opioids for pain management suggests stronger approaches to coordinated long-term multi-disciplinary pain care is needed.