Acute Burn Treatment and History of Drug and Alcohol Addiction: Treatment Outcomes and Opioid Use

Charles S. Hultman,Mohammed Asif,Ashley Modica,Eliana F. R. Duraes,Julie Caffrey,Giulia Sikorski,Ya-Ching Hung

doi:10.3390/ebj3010002

Abstract

Treating pain in burn patients with a history of opioid or drug abuse is challenging. There is no consensus on pain management for burn patients with a history of drug usage. Our aim was to study the association of previous drug addiction and the treatment of acute burn patients, focusing on daily morphine milligram equivalent (MME) requirements and outcomes. We compared patients with (group 1) and without (group 2) a drug addiction history who were admitted to an American Burn Association verified burn center using the Premier database from 2013 to 2018 (n = 3046). Primary outcome was daily MME usage. Secondary outcomes included mortality, expected mortality rate, length of stay (LOS), and number of surgeries. Linear regression was performed to predict MME usage. In total, 16.6% of patients had history of drug abuse. In unadjusted analysis, group 1 had more males (68.1% vs. 57.3%, p < 0.001) and was younger (median 47 vs. median 53, p < 0.001) compared to group 2. In the adjusted analysis, group 1 required 84.1 additional daily MME usage than group 2 (p < 0.01). Drug addiction was associated with an increased number of surgeries, LOS, and higher daily MME usage. Patients with a history of drug usage required almost 60 mg of additional oxycodone per day.

Highlights

Americans consume more opioids than any other country
We focused on burn treatment outcomes and measured additional (MME) requirement for adult burn patients with a history of drug abuse, compared to patients without a history of drug abuse
This study showed additional 84.1 milligram equivalent (MME) was given during admission for burn patients with a history of drug abuse, compared to patients without a history of drug abuse

Summary

Introduction

Americans consume more opioids than any other country. Increased usage of opioids led this country to present the highest overdose death rate in the world [1] (Figure 1).the US government declared the opioid crisis as a public health emergency in2017 [2]. Americans consume more opioids than any other country. Increased usage of opioids led this country to present the highest overdose death rate in the world [1] (Figure 1). The US government declared the opioid crisis as a public health emergency in. In Europe, prescription opioids account for three-quarters of overdose deaths [3]. Data from Beirut and Lebanon showed that opioids were the most common drugs for nonmedical usage among adolescents [3]. The opioid crisis is an extremely relevant topic to burn treatment as illicit drugs and alcohol abuse can be both a predisposing factor for the burn itself and an unwanted consequence of the burn treatment. According to Palmu et al, approximately 50% of adult burn patients were under the influence of alcohol at the time of the burn injury [4]

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