Broken bones, sprains and other physical injuries are often a pathway to opioid abuse, a new study has found. Public health efforts promoting injury prevention might not only help reduce death and disability, but could also reduce addiction to prescription painkillers and illicit opiate drugs, a problem responsible for an estimated 70,000 deaths worldwide each year.

“Primary injury prevention could facilitate reduction of persistent opioid use and thus improve population health and reduce health expenditures,” says Suliman Alghnam, a KAIMRC epidemiologist and public health researcher who also led the study.

The United States has the most cases of opioid abuse and approximately 80% of the world’s opioid supply is consumed there. Doctors often prescribe opioids, such as hydrocodone and oxycodone, to treat pain stemming from car accidents, falls and other kinds of injuries. But the contribution of these debilitating accidents to the growing opioid epidemic in the country was not known.

Alghnam, who now focuses on tracking the burden of traumatic injuries in Saudi Arabia, decided to investigate the link between injuries and persistent opioid abuse in the United States during a postdoctoral fellowship at Johns Hopkins University in Baltimore, Maryland. He and his advisor, Renan Castillo, pored over data from a large government survey that tracks how Americans interact with the medical care system. They identified a population of trauma victims who took opioids at least once immediately after sustaining an injury. Among them, around one in six became repeat users over the course of the two years they were followed. Overall, injuries accounted for about 11% of Americans on long-term opioid treatment.

Alghnam and Castillo then compared the rate of persistent opioid use among those who experienced an injury and those who didn’t. After accounting for socioeconomic variables and other known predictors of drug abuse, the researchers found that injured individuals were about 1.4 times more likely to become chronic opioid users.

Notably, that estimate includes people with fairly mild knocks and bruises. “We certainly feel the magnitude would be higher had we limited the sample to severe cases,” Alghnam says.

So, what’s driving so many Americans to start popping opiate pills after an injury? “Clearly chronic pain is a factor — but so might be overprescribing by physicians,” says Alghnam.

“I think it’s several reasons that would need further research to dismantle,” he says.

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