127 Does Socioeconomic Status Impact Opioid Requirements in Burn Injured Patients with Methamphetamine Abuse?

Abstract

Abstract Introduction Methamphetamine (MA) abuse among burn injured patients is associated with lower socioeconomic status, larger burn injuries, and longer lengths of stay. While overlap among MA and opioid abuse has risen, studies examining the impact of MA abuse and socioeconomic status on opioid requirements in burn injured patients remain limited. The aim of this work was to examine the impact of MA abuse and socioeconomic status on discharge opioid requirements in burn injured patients. Methods Records on burn injured patients admitted to an ABA verified burn center were retrospectively reviewed from January 2016 to December 2017. Demographics, burn size (TBSA), admission toxicity screening, discharge pain scores, length of stay (LOS), adjuvant pain medications, and opioid equivalents (OE) within 24 hours of discharge were reviewed. OEs were determined by conversion of narcotics to oral morphine equivalents. Patients were grouped into methamphetamine positive (MPOS) or negative groups (MNEG) for comparison purposes. Results Of 690 patients who met inclusion criteria, 451 admission toxicity screening exams were performed that identified 170 patients positive for methamphetamine abuse. MNEG patients had significantly higher OE (p=0.03) requirements than MPOS patients. No significant differences were noted between gender (p=0.22), TBSA (p=0.70), benzodiazepine use (p=0.87), or clonidine use (p = 0.88) between groups. MPOS patients were less likely to receive gabapentin (p=0.03). OE and OE/TBSA requirements correlated with discharge pain score (p < 0.001) and LOS (p < 0.001). A significantly higher level of poverty was seen in MPOS patients (p < 0.0001), but poverty itself was not a predictor of OE (p = 0.66), OE/TBSA (p = 0.90), pain score (p = 0.28), or LOS (0.49). Multivariate linear regression found MNEG status (p=0.003), TBSA (p< 0.0001), and pain score (p< 0.0001) were independently associated with OE. Conclusions Though lower socioeconomic status was seen more in patients with MA abuse, it was not associated with opioid use or pain scores. While it is generally believed that MPOS patients require more pain medication, this was not the case in our current study population. Additional work will be necessary to determine techniques to improve pain control. Applicability of Research to Practice Given the opioid crisis, it is critical to understand factors that determine pain medication usage in this patient population to decrease the use of narcotics while improving pain control.