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Original Investigation
February 27, 2019

Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults

Author Affiliations
  • 1National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 2Department of Surgery, University of Michigan Medical School, Ann Arbor
  • 3Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
  • 4Michigan Opioid Prescribing Engagement Network, Ann Arbor
  • 5Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
  • 6Veterans Affairs (VA) Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan
  • 7Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
  • 8Department of Psychiatry, University of Michigan Medical School, Ann Arbor
JAMA Surg. 2019;154(4):e185838. doi:10.1001/jamasurg.2018.5838
Key Points

Question  Is long-term opioid use among family members associated with persistent opioid use among opioid-naive adolescents and young adults undergoing surgical and dental procedures?

Findings  In this cohort study of 346 251 opioid-naive individuals aged 13 to 21 years undergoing common surgical and dental procedures with an initial opioid prescription fill, persistent opioid use occurred in 453 patients (4.1%) with long-term opioid use in family members compared with 5940 patients (2.4%) without long-term opioid use in family members.

Meaning  The findings suggest that long-term opioid use among family members is associated with persistent opioid use among opioid-naive adolescents and young adults undergoing surgery and should be screened for in the preoperative period.

Abstract

Importance  Prior studies have found a substantial risk of persistent opioid use among adolescents and young adults undergoing surgical and dental procedures. It is unknown whether family-level factors, such as long-term opioid use in family members, is associated with persistent opioid use.

Objective  To determine whether long-term opioid use in family members is associated with persistent opioid use among opioid-naive adolescents and young adults undergoing surgical and dental procedures.

Design, Setting, and Participants  This retrospective cohort study used data from a commercial insurance claims database for January 1, 2010, to June 30, 2016, to study 346 251 opioid-naive patients aged 13 to 21 years who underwent 1 of 11 surgical and dental procedures and who were dependents on a family insurance plan.

Exposures  Long-term opioid use in family members, defined as having 1 or more family members who (1) filled opioid prescriptions totaling a 120 days’ supply or more during the 12 months before the procedure date or (2) filled 3 or more opioid prescriptions in the 90 days before the procedure date.

Main Outcomes and Measures  The main outcome measure was persistent opioid use, defined as 1 or more postoperative prescription opioid fills between 91 and 180 days among patients with an initial opioid prescription fill. Generalized estimating equations with robust SEs clustered at the family level were used to model persistent opioid use as a function of long-term opioid use among family members, controlling for procedure, total morphine milligram equivalents of the initial fill, and patient and family characteristics.

Results  A total of 346 251 patients (mean [SD] age, 17.0 [2.3] years; 175 541 [50.7%] female) were studied. Among these patients, 257 085 (74.3%) had an initial opioid fill. Among patients with an initial opioid fill, 11 016 (4.3%) had long-term opioid use in a family member. Persistent opioid use occurred in 453 patients (4.1%) with long-term opioid use in a family member compared with 5940 patients (2.4%) without long-term opioid use in a family member (adjusted odds ratio, 1.54; 95% CI, 1.39-1.71).

Conclusion and Relevance  The findings suggest that long-term opioid use among family members is associated with persistent opioid use among opioid-naive adolescents and young adults undergoing surgical and dental procedures. Physicians should screen young patients for long-term opioid use in their families and implement heightened efforts to prevent opioid dependence among patients with this important risk factor.

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