Long-Term Outcomes of Psychoactive Drug Use in Trauma Patients: A Multicenter Patient-Reported Outcomes Study.

INTRODUCTION Psychoactive drug use (PDU) is reported in up to 40% of trauma patients and is associated with a higher rate of in-hospital complications. However, little is known about its long-term impact on trauma patients. We aimed to assess the long-term functional, mental and psychosocial outcomes of PDU in trauma patients 6-12 months after injury. METHODS Trauma patients with moderate to severe injuries (ISS>9) who had a toxicology screen upon admission to one of three level 1 trauma centers were contacted by phone 6-12 months post-injury. PDU was defined as the presence of a psychoactive, non-prescribed substance on toxicology screen including amphetamine, barbiturate, benzodiazepine, cannabinoid, methamphetamine, methadone, opioid, oxycodone, methylenedioxymethamphetamine (ecstasy), phencyclidine, tricyclic antidepressant and cocaine. The interviews systematically evaluated functional limitations, social functioning, chronic pain, and mental health (PTSD, depression, anxiety). Patients with a score of <47 on the SF-12 social functioning sub-domain were considered to have social dysfunction. Multivariable regression models were built to determine the independent association between PDU and long-term outcomes. RESULTS Of the 1,699 eligible patients, 571 (34%) were included in the analysis, and 173 (30.3%) screened positive for PDU on admission. Patients with PDU were younger (median age: 43[28,55] vs 66[46,78], P< 0.001), had more penetrating injuries (8.7% vs 4.3%, P=0.036), and were less likely to have received a college education (41.3% vs 54.5%, P=0.004). After adjusting for patients' characteristics including the presence of a baseline psychiatric comorbidity, patients with PDU on admission were more likely to suffer from daily chronic pain, mental health disorders, and social dysfunction 6-12 months after injury. There was no difference in the functional limitations between patients with and without PDU. CONCLUSION On the long term, PDU in trauma patients is strongly and independently associated with worse mental health, more chronic pain and severe impairment in social functioning. A trauma hospitalization presents an opportunity to identify patients at risk and to mitigate the long-term impact of PDU on recovery. LEVEL OF EVIDENCE Prognostic/epidemiologic, level III.