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. 2023 Mar 1;6(3):e233385.
doi: 10.1001/jamanetworkopen.2023.3385.

Association of Household Opioid Availability With Opioid Overdose

Michelle A Hendricks  1 , Sanae El Ibrahimi  1   2 , Grant A Ritter  3 , Diana Flores  1 , Michael A Fischer  4 , Roger D Weiss  5   6 , Dagan A Wright  7 , Scott G Weiner  8
Affiliations

Association of Household Opioid Availability With Opioid Overdose

Michelle A Hendricks et al. JAMA Netw Open. .

Abstract

Importance: Previous studies that examined the role of household opioid prescriptions in opioid overdose risk were limited to commercial claims, did not include fatal overdoses, and had limited inclusion of household prescription characteristics. Broader research is needed to expand understanding of the risk of overdose.

Objective: To assess the role of household opioid availability and other household prescription factors associated with individuals' odds of fatal or nonfatal opioid overdose.

Design, setting, and participants: A retrospective cohort study assessing patient outcomes from January 1, 2015, through December 31, 2018, was conducted on adults in the Oregon Comprehensive Opioid Risk Registry database in households of at least 2 members. Data analysis was performed between October 16, 2020, and January 26, 2023.

Exposures: Household opioid prescription availability and household prescription characteristics.

Main outcomes and measures: Opioid overdoses were captured from insurance claims, death records, and hospital discharge data. Household opioid prescription availability and prescription characteristics for individuals and households were modeled as 6-month cumulative time-dependent measures, updated monthly. To assess the association between household prescription availability, household prescription characteristics, and overdose, multilevel logistic regression models were developed, adjusting for demographic, clinical, household, and prescription characteristics.

Results: The sample included 1 691 856 individuals in 1 187 140 households, of which most were women (53.2%), White race (70.7%), living in metropolitan areas (75.8%), and having commercial insurance (51.8%), no Elixhauser comorbidities (69.5%), and no opioid prescription fills in the study period (57.0%). A total of 28 747 opioid overdose events were observed during the study period (0.0526 per 100 person-months). Relative to individuals without personal or household opioid fills, the odds of opioid-related overdose increased by 60% when another household member had an opioid fill in the past 6 months (adjusted odds ratio [aOR], 1.60; 95% CI, 1.54-1.66) and were highest when both the individual and another household member had opioid fills in the preceding 6 months (aOR, 6.25; 95% CI, 6.09-6.40).

Conclusions and relevance: In this cohort study of adult Oregon residents in households of at least 2 members, the findings suggest that household prescription availability is associated with increased odds of opioid overdose for others in the household, even if they do not have their own opioid prescription. These findings underscore the importance of educating patients about proper opioid disposal and the risks of household opioids.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Ritter reported receiving grants from the Jackson Foundation for Military Medicine, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Center For Complementary and Alternative Medicine, and Activity for Community Living outside the submitted work. Dr Weiss reported receiving personal fees from Alkermes, Takeda, Cerevel, and Astellas outside the submitted work, and consulting fees from Alkermes. Dr Weiner reported receiving personal fees from Vertex Pharmaceuticals Inc and Bicycle Health Inc outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Cohort Flowchart
APCD indicates All Payer All Claims Database; ID, identifier.
See this image and copyright information in PMC

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