Prevalence of Opioid Use and Misuse in Individuals with Spinal Cord Injury

Abstract

Background: Opioid analgesics remain a second-line treatment for chronic pain after Spinal Cord Injury (SCI), despite their addictive effects. However, varying estimates of opioid use have been reported in this patient group. Aims: To evaluate the rate of opioid use, in addition to sample (i.e., SCI type, lesion completeness, gender) and methodological characteristics (i.e., opioid measurement, method of data collection) associated with increased use in adults (aged >17 years) with a traumatic or non-traumatic SCI. Methods: A systematic search of CINAHL, Embase, Ovid MEDLINE, PsycINFO, PubMed, Scopus, and Web of Science was conducted. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist, and prevalence rates calculated in addition to 95% confidence intervals, p values, heterogeneity statistics, and failsafe Ns. These analyses followed a random-effects model. Results: Pooled data from 14 independent studies (Nparticipants = 61311) indicated that one in four adults with a SCI had used opioids (.25 [CI: .16-.37], p <.01). Over 30% were prescribed opioids (.33 [CI: .24- .45], p <.01), although few met diagnostic criteria for substance use disorder (.02 [CI: .16 to.37], p <.01). Prevalence estimates remained high regardless of whether data were collected retrospectively or prospectively. Injury and demographic characteristics were also not significant moderators, although these subgroup analyses may have been underpowered. Conclusions: There remains a prescribing culture in spinal injury rehabilitation, with opioid use being highly prevalent. Further research to examine other viable treatments for chronic pain, given the potential for misuse in this population, is warranted.