259 Case Series of Deceptive and Intentional Self-Burning for Narcotics: A Hidden Problem within the Opioid Epidemic

Self-inflicted burns (SIB) as a means to suicide or self-harm account for 1–2% of all burns annually in the US. We have observed a subset of patients at our institution, where SIB is motivated to receive opioids. This group is not forthcoming about how their burn occurred and go to great lengths to deceive medical providers while also displaying drug-seeking behaviors. Though only a small percentage of our burn patients, the number of patients and burn incidents per patient is increasing. This, combined with the challenges involved in managing and caring for the deceptive SIB patient, highlightsthe need for further investigation, particularly in light of the opioid epidemic. This study aims to characterize patients with repeated SIB who intentionally deceive medical providers to obtain opioids. We queried the burn registry and electronic medical record (EMR) to identify all adult burn patients evaluated at the Burn Center from 2005–2018 with 3 or more distinct burn injuries, evidence of SIB, and deception of medical providers, motivated by the desire for opioids. Clinical and demographic data was collected and analyzed. Fifteen patients met inclusion criteria. Patients were white males, aged 20–40 years old, with comorbid chronic pain, psychiatric and substance use diagnoses. Burns were <5% total body service area (TBSA), located on extremities, caused by chemical or flame and reported as accidental and unwitnessed. Review of the EMR revealed evaluations at a minimum of 3 other institutions for each patient, a history of demanding pain medications by name and by intravenous route, and more than 10 prescribers for opioids in the substance database. Psychiatric consultation requests for safety, repeated burns, drug- seeking behaviors and capacity to leave against medical advice were common. All patients adamantly denied self-inflicting the burn when initially asked. Patients with 3 or more burn incidents warrant a thorough review of the EMR and substance database. Burn care is not enough for these patients; treatment for the opioid use and psychiatric disorder(s) are necessary. We have developed a standardized treatment approach; this includes combined assessments by the burn, psychiatry, and addiction consult services and use of medication assisted treatment, when appropriate, as a way to treat the opioid use disorder. Our integrated and multi-disciplinary treatment plan has been a crucial part of caring for this subset of burn patients. This study serves as a platform for providers to recognize the deceptive SIB patient with opioid use disorder and allows providers to anticipate behaviors and intervene appropriately.