129 - The Association of Traumatic Brain Injury with the Development of Opioid Use Disorder Among Youth

Publication Number: 129.6835

Michael S. Toce, Boston Children's Hospital, Boston, MA, United States; Siddharth Jogi, MassGeneral Hospital for Children, Boston, MA, United States; Meredith Glass, MassGeneral Hospital for Children, Boston, MA, United States; Arthur Robin Williams, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Florence Bourgeois, Boston Children's Hospital, Boston, MA, United States; Rebekah Mannix, Boston Children's Hospital, Boston, MA, United States; Scott E. Hadland, Mass General for Children / Harvard Medical School, Boston, MA, United States

Background: Traumatic brain injury (TBI) among youth is common and has been associated with the development of new affective or behavioral disorders. Further, individuals with opioid-use disorder (OUD) are more likely than the general population to have a mental health condition. Whether TBI is associated with subsequent OUD in youth is unknown.

Objective: To test the association of TBI with subsequent OUD development in a large and geographically diverse sample.

Design/Methods: We performed a matched cohort study of youths aged 13-25 years in the Transformed Medicaid Statistical Information System, a dataset with all available inpatient, emergency department, and outpatient claims from Medicaid-enrolled individuals from all US states. We identified youth with a diagnosis of TBI during calendar years 2016-2019, and assessed all available follow-up data through 2021. The diagnosis of TBI encompassed mild conditions such as concussion as well as more severe injuries like traumatic intracranial hemorrhage. Since youth with any painful injury may be at risk for opioid use and OUD, we matched youth with TBI in a 1:1 ratio with individuals presenting for a fracture who were of the same age, sex, and US state. The primary outcome was time to incident diagnosis of OUD. Individuals who unenrolled from Medicaid were right-censored at their last date of observation. We used descriptive statistics to describe the study population and generated Cox proportional hazards models to test the association between TBI and OUD.

Results: We identified 880,947 (39.0% females; mean age 17.2 years [SD 4.0 years]) individuals diagnosed with a TBI between 2016-2019. A greater proportion of individuals with TBI (n=9,806; 1.1%) developed OUD compared to controls (n=8,200; 0.9%). The cumulative incidence of OUD in the TBI group was 550 cases per 100,000 person-years, compared to 546 cases per 100,000 person-years in controls. Individuals diagnosed with TBI were 3.6% (95% CI, 0.6 to 6.7%) more likely to develop OUD compared to their matched controls.

Conclusion(s): In this large matched cohort study, the prevalence of OUD was elevated (0.9-1.1%) compared to the previously reported values in healthcare claims studies (0.2-0.3%). Individuals with TBI were more likely to develop OUD compared to matched individuals with painful injuries, although the relative hazard was only marginally higher. Given the high prevalence of TBI among youth, additional studies exploring this relationship are warranted.