How does drug abuse affect outcomes after trauma? A trauma quality improvement program study.

Summary

In 861,450 trauma admissions with toxicology testing, several positive drug screens (e.g., opioids, cannabinoids, amphetamines) were associated with lower odds of mortality, ICU admission, and intubation; methamphetamine positivity correlated with reduced ARDS odds. Findings are hypothesis-generating and susceptible to confounding, warranting careful causal inference work.

Key Findings

• Across 861,450 trauma patients, positive screens for cannabinoids, amphetamines, cocaine, opioids, and benzodiazepines were associated with lower mortality odds (all P<0.001).
• Opioid, barbiturate, oxycodone, ecstasy, and methadone positivity correlated with reduced ICU admission odds.
• Opioid, barbiturate, oxycodone, and ecstasy positivity were linked to lower intubation odds; methamphetamine positivity was associated with reduced ARDS odds.

Clinical Implications

Do not infer benefit from recreational drug exposure; instead, recognize potential confounding and consider toxicology as a prognostic covariate in risk models and triage decisions.

Limitations

• Retrospective design with potential selection bias in toxicology testing and unmeasured confounding (dose, timing, polysubstance use)
• Causality cannot be inferred; misclassification of exposure likely

Future Directions

Prospective or quasi-experimental studies, causal inference with propensity/synthetic control, and mechanistic work on stress response modulation by substances.