The Prevalence, Chronology, and Clinical Correlates of Traumatic Brain Injury Among Individuals Seeking Treatment for Opioid Use Disorder.

Abstract

Objective: Investigate the prevalence and characteristics of traumatic brain injuries (TBI) among persons with opioid use disorder (OUD), establish the chronology of comorbid TBI and first opioid use, and evaluate the relation between TBI and factors associated with greater harm potential of OUD.

Setting: Outpatient OUD treatment clinics.

Participants: Adults undergoing outpatient treatment for OUD (N = 158).

Design: Observational.

Main measures: The Ohio State University Traumatic Brain Injury Identification Method; Alcohol Use Disorders Identification Test.

Results: A history of at least 1 TBI was reported by 48.7% of the sample. Of persons with a history of TBI, 44.2% reported multiple TBI. The odds of incurring TBI before ever using opioids were 1.5 times higher than the reverse progression. Approximately 90% of participants with TBI had been prescribed an opioid medication by a healthcare professional, which was significantly higher than for persons without TBI. Participants with TBI were at elevated risk of overdose, use of certain substances (eg, amphetamines, cocaine, sedatives, fentanyl), and riskier routes of opioid administration, as compared to patients without TBI. Use of certain substances (eg, alcohol, marijuana) and most psychosocial/demographic characteristics did not differ by TBI history.

Discussion: TBI is a relatively frequent comorbidity for patients enrolled in OUD treatment. Among individuals with a history of TBI, 55.8% incurred their injury before ever using opioids. Individuals with TBI may be more likely to experience greater harm from OUD. These findings support the routine assessment of substance use and TBI in medical settings and the consideration of these factors for treatment planning.