Understanding Chronic Pain and Opioid Use After Traumatic Brain Injury: Leveraging Integrated Data to Identify High-risk Use Patterns

This project aims to characterize high-risk opioid use patterns in a large civilian population following traumatic brain injury (TBI) using a novel, integrated dataset. The study combines trauma registry data, electronic medical records, and Washington State Prescription Monitoring Program (PMP) records to track opioid prescribing from acute hospitalization through the first year post-injury.

The observational cohort includes over 11,000 adults treated for TBI at Harborview Medical Center—a regional Level I trauma center—between 2012 and 2020. Opioid prescription patterns were assessed quarterly using validated metrics from the Bree Collaborative, such as overlapping prescriptions, high-dose prescribing, and concurrent sedative use.

Preliminary findings show that approximately 12% of patients filled an opioid prescription in each quarter after discharge, dropping to 5% by the fourth quarter. Among those prescribed opioids, 26% per quarter received at least a 60-day supply, 13% exceeded the 50 morphine milligram equivalent (MME) threshold, and fewer than 1% had long-term concurrent sedative prescriptions. Data also reveal persistent opioid use in a subset of patients up to one year post-TBI.

Early descriptive trends suggest a reduction in opioid prescribing following the 2017 implementation of statewide opioid policy reforms, with a plateauing trend during the early COVID-19 pandemic. Final analyses will examine how demographic factors (age, gender, race) and care pathways (e.g., inpatient rehabilitation) influence high-risk prescribing trajectories.

By integrating diverse data sources, this study provides critical insight into chronic pain management and opioid risk following TBI. The findings will inform the development of targeted interventions and policy strategies to reduce long-term opioid-related harm in this vulnerable population.