|
Abstract
|
BY THE TIME THE US Department of Health and Human Services declared the opioid epidemic a public health emergency in 2017, prescription opioid rates had been declining for several years. Yet, alarmingly, despite broad, multifaceted policy changes and interventions launched to curb the epidemic, opioid-related overdose deaths have increased by almost 5% from 2018 to 2019. Mortality associated with the opioid epidemic has been characterized by 3 waves, with the first wave fueled by increasing prescription opioid medications beginning in the 1990s, the second wave characterized by overdose deaths involving heroin starting around 2010, and the third wave driven by overdose deaths involving synthetic opioids (eg, fentanyl) starting in 2013.
In recent years, traumatic brain injury (TBI) researchers, rehabilitation providers, funders, family members, and persons living with TBI have directed attention to understanding how the opioid epidemic has affected persons with TBI in the United States.6 There was speculation that persons with TBI may be at a greater risk for receiving prescription opioids due to secondary conditions common after injury (eg, pain); however, systematic study was lacking. Recently, Drs Corrigan, Dams-O'Connor, and I published a commentary, "Opioid Use Among Individuals With Traumatic Brain Injury: A Perfect Storm?" in which we synthesized existing literature, highlighted gaps in knowledge, and posited that for some individuals with TBI, risk factors may converge to create a "perfect storm," placing them at an increased risk for opioid use and associated consequences. We developed a 3-phase model for the "perfect storm," which posits that there are cascading vulnerabilities that can make persons with TBI uniquely susceptible to devastating consequences from opioid use, with each phase increasing risk for progression to the next (see Figure 1). Briefly, phase I contends that persons with TBI have greater exposure to opioids. Phase II states that, given opioid exposure, persons with TBI have a greater risk for advancing to long-term opioid therapy (LTOT; a risk factor for overdose and development of dependence), opioid misuse, or opioid use disorder (OUD). Finally, phase III hypothesizes that if persons with TBI do develop OUD, they may face greater barriers to successfully engage in OUD treatment.
Language: en |