S. M. Miller1, S. N. Lueckel1, D. S. Hefferenan1, A. H. Stephen1, M. D. Connolly1, T. Kheirbek1, W. G. Cioffi1, C. A. Adams1, S. F. Monaghan1 1Brown University School Of Medicine,Surgery,Providence, RI, USA
Introduction: Each day 78 people die from opioid-related overdoses in the United States. With heightened public awareness, the number of people in methadone treatment programs has increased. Methadone treatment was not intended to be a chronic medication and we predict methadone treatment will be associated with adverse outcomes in trauma patients.
Methods: The trauma registry of a single level-one trauma center was queried between 2011 and 2016 for patients who were tested for drug use and were grouped based on their methadone use. First demographic and outcome measures were compared among all patients. Then, case-control matching (2 controls for every case) was then performed for between groups, matching for age, gender, Glasgow coma scale (GCS), and injury severity score (ISS). Regression analysis was used to identify variables affecting patient outcomes. Alpha was set to 0.05.
Results:6848 patients tested for drugs on admission were identified from the trauma registry; 175 were in the methadone group and 6673 were controls. Patients on methadone were younger (43 years vs 52, p<.001) but had similar gender, racial and ethnicity group distributions. There was no significant difference in mechanism of injury, ISS, or GCS on admission. Methadone patients were more likely to have a psychiatric illness (29% vs 17%, p<.001), to smoke (62% vs 31, p<.001) and to use illegal drugs (90% vs 63%, p<.001), while they were less likely to have hypertension (15% vs 32%, p<.001), diabetes (6% vs 11%, p<.05), and congestive heart failure (2% vs 5%, p<.05). The hospital mortality was lower in the methadone group (3% vs 6%, p<.05). Case-control matching yielded a cohort of 509 patients, 170 of whom were on methadone. In the matched sample (with similar age, gender, GCS and ISS), methadone patients were more likely to have a psychiatric illness (30% vs 7%, p<.001), to smoke (62% vs 45%, p<.001) and to use illegal drugs (89% vs 68%, p<.001). Similarly, methadone patients demonstrated lower mortality (2% vs 17%, p<.001) but were observed to have longer lengths of stay in the hospital (9 days vs 7, p<.05). In addition, patients receiving methadone treatment were less likely to be discharged home with no services (51% vs 82%, p<.001). Regression analyses revealed that methadone patients had lower mortality (OR = 21, 95% CI 5.5-79, p<.001) when adjusting for patient and injury characteristics.
Conclusion: Counter to our hypothesis, patients on methadone were more likely to survive than those not taking methadone. Chronic narcotics may have a salutary effect on injured-induced immune-inflammatory activation. However, patients on methadone were hospitalized for two days longer. This potentially speaks to difficulty in placing patients with services due to the methadone use.