Objective: To summarize the current literature to identify what research has been conducted, examine the approaches used, and determine what is presently known about prescription and nonprescription opioid receipts and use among individuals with traumatic brain injury (TBI). Data Sources: The search strategy included the following: Opioid; opiate; analgesics, opioid; opiate alkaloids; or opioid-related disorders; AND brain injury; brain injuries; brain injuries, traumatic; head injury; head injuries; head injuries, closed; head injuries, penetrating; brain concussion; diffuse axonal injury; diffuse axonal injuries; brain trauma/s; head trauma/s; concussion; craniocerebral trauma/s; or TBI. Filters included English and Adults (19+ years). Study Selection: Inclusion: English language, adults with stable TBI, and prescription opioid receipt or use after TBI. Exclusion: Animal models, populations with other acquired brain injury, acute TBI management, and non-peer-reviewed articles, theses, or conference abstracts. Multiple reviewers screened abstracts and full-text articles for eligibility. In total, 771 abstracts were screened, 183 full texts were reviewed, and 21 met eligibility criteria. Data Extraction: Relevant content was independently extracted by multiple observers, including authors, design, sample identification and data source/s, TBI severity, TBI assessment, opioid assessment, study population (demographics, N), military affiliation, comparison groups, date of data collection, and summary of findings. Results: Studies were published between 1987 and 2019; most data were collected prior to 2015. The majority utilized administrative and electronic medical record data from the Department of Veterans Affairs and retrospective cohort designs, and most focused on prescription opioids. There were no studies evaluating interventions to reduce use of opioids in TBI populations. Preliminary findings suggest that prescription opioid receipt is strongly related to psychological symptoms, including comorbid depression, anxiety, and posttraumatic stress disorder. Conclusions: Despite increased awareness of opioid receipt and use following TBI, there is limited investigation on the examination of this issue. Future studies should include more varied patient populations as well as evaluate interventions to reduce opioid use following TBI.
Bibliographical noteFunding Information:
Drs Starosta and Hoffman’s effort on this article was supported by grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR): TBI Model System Centers Collaborative Research Project Grant (90DPTB0017) and The University of Washington TBI Model Systems grant (90DPTB0008). Dr Adams effort on this article was supported by a grant from the NIDILRR (90DPGE0007). Ms Mar-witz’s and Dr Kreutzer’s effort was supported in part by the Administration for Community Living (ACL; grant 90TBSG0035-01-00), US Department
of Health and Human Services, the Virginia Department for Aging and Rehabilitative Services (DARS; state contract 1A262-80504), and the Virginia Commonwealth University TBI Model System grant (90DPTB0005). Dr Monden’s effort was supported by the TBI Model System Centers Collaborative Research Project grant (90DP0084) and Craig Hospital TBI Model Systems grant (90DPTB00070). Dr Dams O’Connor’s effort was supported by the New York Traumatic Brain Injury Model System at Mount Sinai (90DPTB0009-01-01) and the National Institutes of Health/National Institute of Neurological Disorders and Stroke (1RF1 NS115268-01). NI-DILRR is a center within the ACL, Department of Health and Human Services (HHS). The contents of this brief do not necessarily represent the policy of NIDILRR, ACL, HHS, Veterans Health Administration, or DARS, and you should not assume endorsement by the federal government.
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- Brain injury