Community Opioid Dispensing after Injury (CODI): Cohort characteristics and opioid dispensing patterns

Background: Despite a focus of opioid-related research internationally, there is limited understanding of longterm opioid use in adults following injury. We analysed data from the 'Community Opioid Dispensing after Injury' data linkage study. Aims: This paper aims to describe the baseline characteristics of the injured cohort and report opioid dispensing patterns following injury -related hospitalisations. Methods: Retrospective cohort study of adults hospitalised after injury (ICD-10AM: S00 -S99, T00 -T75) in Queensland, Australia between 1 January 2014 and 31 December 2015, prior to implementation of opioid stewardship programs. Data were person -linked between hospitalisation, community opioid dispensing and mortality collections. Data were extracted for 90 -days prior to the index hospital admission, to establish opiate naivety, to 720 days after discharge. Median daily oral morphine equivalents (i.e., dose) were averaged for each 30 -day interval. Cumulative duration of dispensing and dose were compared by demographic and clinical characteristics, stratified by drug dependency status. Results: Of the 129,684 injured adults, 61.3 % had no opioids dispensed in the 2 -year follow-up period. Adults having any opioids dispensed in the community (38.7 %) were more likely older, female, to have fracture injuries and injuries with a higher severity, compared to those with no opioids dispensed. Longer durations and higher doses of opioids were seen for those with pre -injury opioid use, more hospital readmissions and repeat surgeries, as well as those who died in the 2 -year follow-up period. Median dispensing duration was 24 -days with a median daily end dose of 13 oral morphine equivalents. If dispensing occurred prior to the injury, duration increased 10fold and oral morphine equivalents doubled. Adults with a documented dependency prior to, or after, the injury had significantly longer durations of use and higher doses than the rest of the cohort receiving opioids. Approximately 7 % of the total cohort continued to be dispensed opioids at 2 -years post injury. Conclusion: This is a novel population -level profile of opioid dispensing patterns following injury -related hospitalisation, described for the time period prior to the implementation of opioid stewardship programs and regulatory changes in Queensland. Detailed understanding of this pre -implementation period is critical for evaluating the impact of these changes moving forward.