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Original Investigation
December 16, 2019

Association of Opioid Prescribing Patterns With Prescription Opioid Overdose in Adolescents and Young Adults

Author Affiliations
  • 1Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor
  • 2Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
  • 3Michigan Opioid Prescribing Engagement Network, Ann Arbor
  • 4Questrom School of Business, Institute for Health System Innovation and Policy, Department of Markets, Public Policy, and Law, Boston University, Boston, Massachusetts
  • 5Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Health System, Ann Arbor, Michigan
  • 6Department of Psychiatry, University of Michigan Medical School, Ann Arbor
JAMA Pediatr. 2020;174(2):141-148. doi:10.1001/jamapediatrics.2019.4878
Key Points

Question  In adolescents and young adults without cancer, which opioid prescribing patterns are associated with prescription opioid overdose?

Findings  In this claims-based cohort study of 2 752 612 adolescents and young adults without cancer, daily opioid dosage, concurrent benzodiazepine use, and extended-release or long-acting opioid use were associated with increased overdose risk.

Meaning  The findings suggest that when prescribing opioids to adolescents and young adults, practitioners could potentially mitigate overdose risk by using the lowest effective dosage, avoiding concurrent opioid and benzodiazepine use, and relying on short-acting opioids.

Abstract

Importance  Safe opioid prescribing practices are critical to mitigate the risk of prescription opioid overdose in adolescents and young adults. However, studies that examine opioid prescribing patterns associated with prescription opioid overdose have mostly focused on older adults. The generalizability of these studies to adolescents and young adults is unclear.

Objective  To identify opioid prescribing patterns associated with prescription opioid overdose in adolescents and young adults.

Design, Setting, and Participants  This retrospective cohort study assessed privately insured patients aged 12 to 21 years with opioid prescription claims in the IBM MarketScan Commercial Claims and Encounters database between July 1, 2009, and October 1, 2017, and no cancer diagnosis. Data analysis was performed from January 1 to April 30, 2019.

Main Outcomes and Measures  The outcome was a treated opioid overdose as indicated by diagnosis codes. On the basis of days supplied, opioid prescription claims were converted to person-days (the unit of analysis) on which opioid exposure would occur if patients took medications as prescribed. Logistic regression with clustered SEs at the patient level was used to model the occurrence of overdose on a person-day as a function of daily opioid dosage category (<30, 30-59, 60-89, 90-119, or ≥120 morphine milligram equivalents), concurrent benzodiazepine use, and extended-release or long-acting opioid use. Regressions controlled for demographic characteristics, year, opioid use within 180 days, and comorbidities (mental health disorder, substance use disorder, and other chronic condition).

Results  A total of 2 752 612 patients (mean [SD] age at cohort entry, 17.2 [2.5] years; 1 451 918 [52.8%] female) participated in the study. Patients had 4 686 355 opioid prescription claims, corresponding to 21 605 444 person-days. Overdose occurred on 255 person-days among 249 patients (0.01% of the sample). Each increase in daily opioid dosage category was associated with higher overdose risk (adjusted odds ratio [AOR], 1.18; 95% CI, 1.05-1.31). Compared with no use, both concurrent benzodiazepine use (AOR, 1.83; 95% CI, 1.24-2.71) and extended-release or long-acting opioid use (AOR, 2.01; 95% CI, 1.16-3.46) were associated with increased overdose risk.

Conclusions and Relevance  The findings suggest that when prescribing opioids to adolescents and young adults, practitioners could potentially mitigate overdose risk by using the lowest effective daily dosage, avoiding concurrent opioid and benzodiazepine prescribing, and relying on short-acting opioids. Findings are broadly consistent with prior opioid safety studies focused on older adults.

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