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. 2022 Jul 1;5(7):e2221316.
doi: 10.1001/jamanetworkopen.2022.21316.

Association of Postsurgical Opioid Refills for Patients With Risk of Opioid Misuse and Chronic Opioid Use Among Family Members

Denis Agniel  1   2 , Gabriel A Brat  2   3 , Jayson S Marwaha  2   3 , Kathe Fox  2   4 , Daniel Knecht  4 , Harold L Paz  4 , Mark C Bicket  5   6 , Brian Yorkgitis  7 , Nathan Palmer  2 , Isaac Kohane  2
Affiliations

Association of Postsurgical Opioid Refills for Patients With Risk of Opioid Misuse and Chronic Opioid Use Among Family Members

Denis Agniel et al. JAMA Netw Open. .

Abstract

Importance: The US health care system is experiencing a sharp increase in opioid-related adverse events and spending, and opioid overprescription may be a key factor in this crisis. Ambient opioid exposure within households is one of the known major dangers of overprescription.

Objective: To quantify the association between the postsurgical initiation of prescription opioid use in opioid-naive patients and the subsequent prescription opioid misuse and chronic opioid use among opioid-naive family members.

Design, setting, and participants: This cohort study was conducted using administrative data from the database of a US commercial insurance provider with more than 35 million covered individuals. Participants included pairs of patients who underwent surgery from January 1, 2008, to December 31, 2016, and their family members within the same household. Data were analyzed from January 1 to November 30, 2018.

Exposures: Duration of opioid exposure and refills of opioid prescriptions received by patients after surgery.

Main outcomes and measures: Risk of opioid misuse and chronic opioid use in family members were calculated using inverse probability weighted Cox proportional hazards regression models.

Results: The final cohort included 843 531 pairs of patients and family members. Most pairs included female patients (445 456 [52.8%]) and male family members (442 992 [52.5%]), and a plurality of pairs included patients in the 45 to 54 years age group (249 369 [29.6%]) and family members in the 15 to 24 years age group (313 707 [37.2%]). A total of 3894 opioid misuse events (0.5%) and 7485 chronic opioid use events (0.9%) occurred in family members. In adjusted models, each additional opioid prescription refill for the patient was associated with a 19.2% (95% CI, 14.5%-24.0%) increase in hazard of opioid misuse in family members. The risk of opioid misuse appeared to increase only in households in which the patient obtained refills. Family members in households with any refill had a 32.9% (95% CI, 22.7%-43.8%) increased adjusted hazard of opioid misuse. When patients became chronic opioid users, the hazard ratio for opioid misuse among family members was 2.52 (95% CI, 1.68-3.80), and similar patterns were found for chronic opioid use.

Conclusions and relevance: This cohort study found that opioid exposure was a household risk. Family members of a patient who received opioid prescription refills after surgery had an increased risk of opioid misuse and chronic opioid use.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Paz reported being an employee of CVS Health/Aetna Inc and receiving personal fees for serving on the boards of USPI, Select Medical, and Curai Health outside the submitted work. Dr Bicket reported receiving personal fees from Axial Healthcare and Alosa Health outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Hazard Ratios for Associations Between All Opioid Exposures in Patients and Opioid Misuse and Chronic Opioid Use in Family Members
HR indicates hazard ratio.
Figure 2.
Figure 2.. Rate of Opioid Misuse and Chronic Opioid Use in Family Members by Number of Refills for the Patient, Adjusted and Unadjusted for Covariates
Figure 3.
Figure 3.. Rate of Opioid Misuse in Family Members by Duration of Exposure and Number of Refills for the Patient
Figure 4.
Figure 4.. Age-Specific Estimates of Risk of Opioid Misuse and Chronic Opioid Use Among Family Members by Exposure to Refills for the Patient
Whiskers indicate 95% CIs.
See this image and copyright information in PMC

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