Abstract
Family members are cited as a common source of prescription opioids used for nonmedical reasons. However, the overdose risk associated with exposure to opioids prescribed to family members among adolescents and young adults is not well established. To assess the association of opioids prescribed to family members with pharmaceutical opioid overdose among youth. This cohort study included 45 145 family units with a total of 72 040 adolescents and young adults aged 11 to 26 years enrolled in a Kaiser Permanente Colorado health plan in 2006 and observed through June 2018. Opioid prescriptions and dosage dispensed to family members and youth in the past month. Fatal pharmaceutical opioid overdoses identified in vital records and nonfatal pharmaceutical opioid overdoses identified in emergency department and inpatient settings. Time to first overdose was modeled using Cox regression. The study population consisted of 72 040 adolescents and young adults (mean [SD] age across follow-up, 19.3 [3.7] years; 36 646 [50.9%] girls and women) nested in 45 145 family units. Youth were more commonly exposed to prescription opioids dispensed to a family member than through their own prescriptions. During follow-up, 26 284 youth (36.5%) filled at least 1 opioid prescription, and 47 461 youth (65.9%) had at least 1 family member with a prescription. Exposure to family members with opioid prescriptions in the past month was associated with increased risk of pharmaceutical opioid overdose (adjusted hazard ratio [aHR], 2.17; 95% CI, 1.24-3.79) independent of opioids prescribed to youth (aHR, 6.62; 95% CI, 3.39-12.91). Concurrent exposure to opioid prescriptions from youth and family members was associated with substantially increased overdose risk (aHR, 12.99; 95% CI, 5.08-33.25). High dosage of total morphine milligram equivalents (MME) prescribed to family members in the past month was associated with youth overdose (0 MME vs >0 to <200 MME: aHR, 1.39; 95% CI, 0.51-3.81; 0 MME vs 200 to <600 MME: aHR, 1.49; 95% CI, 0.59-3.77; 0 MME vs ≥600 MME: aHR, 2.93; 95% CI, 1.55-5.56). In this study of youth linked to family members, exposure to family members' prescribed opioids was associated with increased risk of pharmaceutical opioid overdose, independent of opioids prescribed to youth. Further interventions targeting youth and families are needed, including counseling patients about the risks of opioids to youth in their families.
Highlights
Exposure to family members with opioid prescriptions in the past month was associated with increased risk of pharmaceutical opioid overdose independent of opioids prescribed to youth
Concurrent exposure to opioid prescriptions from youth and family members was associated with substantially increased overdose risk
High dosage of total morphine milligram equivalents (MME) prescribed to family members in the past month was associated with youth overdose (0 MME vs >0 to
Summary
Growing evidence suggests that the family plays an important role in the spread and consumption of prescription opioids by providing access to opioids and facilitating the sharing of information and practices related to their use.[14,15,16,17,18] opioids prescribed to youth and their family members represent 2 distinct but potentially linked sources of exposure that together put youth at risk of overdose. The relative associations of opioids prescribed to youth and their family members with overdose have not been well established. We conducted a retrospective cohort study that linked youth and their family members in a health plan and tested the association of opioid prescribing to the family with pharmaceutical opioid overdose among youth. Our objectives were to assess overdose risk associated with past-month opioid prescriptions to youth and to their family members as well as with opioid dosages and timing of exposures
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