Traumatic spinal cord injury (SCI) affects hundreds of thousands of people worldwide and is associated with permanent, substantial disability. One such outcome is debilitating chronic pain, for which the majority of patients are prescribed opioid medications. Although opioids are an effective management strategy for chronic pain, incorrect dosage or long-term use can lead to depression, cognitive impairment, drug tolerance, addiction, or death. Because opioid use among SCI survivors is common, it is important to observe the repercussions of prolonged or excessive opioid use in this vulnerable population.

The recommended prescription duration of any opioid is 90 days or fewer. Any opioid prescription that consists of more than 90 days’ worth of pills is considered “chronic,” and a prescription that exceeds 90 days and a 90mg of a morphine equivalent is considered “chronic high-dose.” In order to obtain more information about chronic opioid use in regard to SCI treatment, a research team in collected data from 1,842 SCI patients who were injured between 2004 and 2015.

The patients were then observed from April 1, 2016 to March 31, 2017 to monitor distribution and use of opioids. The researchers determined that:

• Men were more likely to develop a chronic opioid problem than women.
• Risk factors for chronic high-dose opioid use included middle age (40-50 years old), extended period since injury, and increasing comorbidity.
• Although the maximum recommended dose is 90mg, the median daily dose of a morphine equivalent was 212mg.
• More than 1 in 3 patients were given at least one opioid during the observation period.

While further research is required to determine the effects of such high doses of opioids on SCI patients, these results provide valuable information about who is at the highest risk for chronic opioid use. According to the study, males (especially those between the ages of 40-50) are the most likely to die from opioid-related deaths. Given that the United States currently is experiencing a devastating “opioid epidemic,” the authors suggest that opioid distribution policies should be made stricter to avoid further damage and poor outcomes caused by over-prescribing.

Guilcher S, Hogan M, Guan Q, et al. Prevalence of prescribed opioid claims among persons with traumatic spinal cord injury in Ontario, Canada: A population-based retrospective cohort study. Archives of Physical Medicine and Rehabilitation. (January 2021).