Personality, High-Risk Behaviors, and Elevated Risk of Unintentional Deaths Related to Drug Poisoning Among Individuals With Spinal Cord Injury

Objective: To identify risk and protective factors for unintentional death related to drug poisoning from prescription medications, including opioid-related deaths, and death due to all other causes among participants with spinal cord injury (SCI). Design: Prospective cohort study. Setting: Large specialty hospital in the southeastern United States. Participants: Two cohorts of SCI participants (N = 3070) (>18y) with chronic (>1y) traumatic SCI. Cohort 1 was enrolled in 1997-1998 (n = 1386), and cohort 2 was enrolled in 2007-2009 (n = 1684). Interventions: N/A. Main Outcome Measures: Participants completed self-report assessments including multiple behavioral variables (alcohol, smoking, prescription medication), as well as the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). The primary outcome is unintentional death related to drug poisoning. Mortality status was determined as of December 31, 2014, using the National Death Index. The Centers for Disease Control guidelines were used for classifying participants into 3 groups: (1) unintentional death related to drug poisoning, (2) other death, and (3) alive. Results: There were 690 deaths (23%), including 24 unintentional deaths related to drug poisoning (11 from opioids). Binge drinking, medication usage total score, and impulsive-sensation seeking were risk factors for unintentional death related to drug poisoning, whereas the ZKPQ activity scale was protective. Risk factors for other causes of death included older age, greater injury severity, being nonambulatory, regular smoker, medication use total score, and greater neuroticism-anxiety scale scores. Conclusions: Unintentional deaths related to prescription drug overdose are associated with a set of risk factors that differs in meaningful ways from risk of death due to other causes after SCI, and these differences hold the key to prevention strategies. (C) 2018 by the American Congress of Rehabilitation Medicine