Effects of Opioid Use Duration on Complications and Healthcare Utilization and Costs in Spinal Cord Injury

Background: Chronic pain management with opioids after spinal cord injury (SCI) has been shown to be ineffective, leading to overuse in length and dosage. Objectives: To assess how the length of opioid use affects associated complications and healthcare usage and costs over 12 months following injury. Methods: Adults with SCI from MarketScan Database (2000-2021) were followed up 12 months pre- and post-injury. Opioid use (OU) was screened from injury. Individuals were then classified accordingly: no use (No OU), 3 months use (OU 3m), 3 to 6 months use (OU 3-6m), and 6 to 12 months use (OU 6-12m). Related complications, healthcare utilization, and payment outcomes were compared using multivariable generalized linear regressions. Results: Cohort was composed of 9630 individuals (median age 54; 59% males). Prolonged-use group (OU 6-12m) had a different profile compared to the No OU group: younger, higher rates of males, bone fracture, thoracic injuries, and Medicaid insurance (median age 49 vs. 58; males 62% vs. 56%, fracture 58% vs. 50%, thoracic 29% vs. 21%, Medicaid 32% vs. 24%; all Ps < .0001). A year after SCI, opioid-related complications were constipation, respiratory depression, hypotension, urinary retention, and nausea/vomiting, with an associated cost 2.4 times higher in OU 6-12m compared to No OU ($6958 vs. $2842). Opioid users (>3 months) had more ER visits and higher hospitalization rates compared to No OU. Combined payments (ER, hospitalizations, PT/OT/SLT, outpatient services, and medication refills) were higher for OU 6-12 ($33,014) and OU 3-6m ($22,351) compared to No OU ($13,896; P < .0001). Conclusion: Considering risk profiles may predict prolonged opioid use and could help clinicians design care management plans to reduce complications and the associated healthcare utilization and payments.