(0521) Opioid Dependency After Craniomaxillofacial Trauma Surgery

Introduction: The opioid crisis has led to significant concern over inappropriate prescriptions. The impact of previous opioid use on prescribing practices is unknown. A prior study estimated 39% of prescriptions for opioid-naïve craniomaxillofacial trauma patients (CMF-TP) from 2006-2015 were potentially inappropriate prescriptions (PIP). The goals of this study were to 1) explore differences in prescribing behavior for opioid-naïve vs opioid-using patients after CMF trauma from 2012-2022 and 2) compare the current rate of PIP in opioid-naïve CMF-TP to the prior estimate.

Methods: This claims database study uses the Merative™ MarketScan® Commercial Database. Using CPT and ICD-9/10 codes, adult CMF-TP were identified and stratified based on whether they had an opioid prescription in the 6 months before CMF trauma. Patients were excluded if they had non-CMF trauma within 30 days of CMF trauma or polytrauma at the time of their CMF injury. Demographics, comorbidities, CMF trauma type, and opioid prescription length were analyzed. PIPs were defined as prescriptions resulting in greater than 100 oral morphine milligram equivalents daily or co-prescription with benzodiazepines/long-acting opioids.

Results: A total of 762 CMF-TP were identified. CMF-TP were primarily young (median 28), male (71%), and had isolated mandible fractures (63%). A large portion (93%) of the cohort were prescribed opioids after repair. Of the total, 440 (59%) were opioid-naïve, and the remainder used opioids within 6 months prior to trauma. PIP occurred in 12% of opioid-naive versus 17% of opioid-using CMF-TP. In addition, opioid use for 3 months or more after trauma occurred in 6% of opioid-using compared to only 0.5% of opioid-naïve patients. The observed value of 12% of PIP in opioid-naïve patients is substantially lower than the previous estimate.

Conclusions: CMF-TP are frequently prescribed opioids, and PIP are more common in patients with prior opioid use. PIP are substantially lower in opioid-naïve patients compared to the estimate from 7 years prior. Future research should focus on strategies to reduce PIP in CMF-TP with prior opioid use.