Comparing marijuana and opioid misuse and behavioral health outcomes in moderate-severe traumatic brain injury

Research Objectives: To operationalize cut points for “Opioid Misuse” and “Marijuana Use” using the Traumatic Brain Injury Model Systems (TBIMS) Pain Collaborative Dataset and to describe the interaction of opioid misuse and marijuana on behavioral and psychosocial outcomes

Design: Cross-sectional analysis of TBIMS Pain Collaborative data

Setting: Community

Participants: Persons with TBI (n =2,314) enrolled in the TBIMS National Database who completed the Pain Collaborative survey

Interventions: N/A

Main Outcome Measures: Proportion of opioid misusers as classified by reporting using more than the prescribed dosage of opioids or using non-prescribed opioids; distribution of opioid misuse across categories of marijuana use; proportion and significance of substance and alcohol use and clinically significant PTSD (PTSD checklist-5), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and sleep quality (Pittsburg Sleep Quality Index).

Results: Among opioid users (n = 898, 38.8% of sample), there were 106 (11.8% of opioid users) who reported misusing opioids. There was statistically significant variation among the different Opioid misuse/Marijuana Categories in demographics (age), injury characteristics (cause of injury, GCS) and behavioral/psychosocial measures such as substance/alcohol use, PTSD symptoms, depression, anxiety, and sleep quality (p < 0.01). Those who misused opioids and/or used marijuana had higher rates of clinically significant behavioral outcomes than those who did not misuse opioids/and or used marijuana.

Conclusions: It is important to understand how people use opioids and marijuana after TBI as there is an association with poorer behavioral health outcomes among substance users. These findings can help clinicians discuss the impacts of substance use on health outcomes with individuals with TBI and chronic pain.

Author(s) Disclosures: This work was supported by two grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPTB0017). NIDILRR is a center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.