Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults
Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults
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DOI：
10.1001/jamasurg.2018.5838
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发表时间：
2019-04-01
期刊：
影响因子：
16.9
通讯作者：
Waljee, Jennifer F.
中科院分区：
文献类型：
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作者：
Harbaugh, Calista M.;Lee, Jay S.;Waljee, Jennifer F.
先前的研究发现，在接受手术和牙科手术的青少年和年轻人中持续使用阿片类药物的风险很大。目前尚不清楚家庭因素，如家庭成员长期使用阿片类药物，是否与持续使用阿片类药物有关。目的：确定家庭成员长期使用阿片类药物是否与接受手术和牙科手术的阿片类药物初治青少年和年轻人持续使用阿片类药物有关。这项回顾性队列研究使用了2010年1月1日至2016年6月30日商业保险索赔数据库的数据，研究346251名13至21岁的阿片类药物初治患者，他们接受了11种外科和牙科手术中的1种，并且依赖于家庭保险计划。定义为有1名或多名家庭成员（1）在手术日期前12个月内填写阿片类药物处方，总计120天或更长时间，或（2）主要结果和测量主要结果测量是持续使用阿片类药物，定义为在初始阿片类药物处方填充的患者中，在91和180天之间，1次或多次术后处方阿片类药物填充。在家庭水平上具有稳健SE的广义估计方程用于模拟持续阿片类药物使用作为家庭成员长期阿片类药物使用的函数，控制程序，初始填充的总吗啡毫克当量以及患者和家庭特征。（平均[SD]年龄，17.0 [2.3]岁; 175541 [50.7%]女性）。在这些患者中，257 085例（74.3%）接受了初始阿片类药物填充。在初始阿片类药物填充的患者中，11016例（4.3%）家庭成员长期使用阿片类药物。453例患者持续使用阿片类药物（4.1%）与5940例患者相比，家庭成员长期使用阿片类药物（2.4%）没有长期使用阿片类药物的家庭成员（调整后的比值比，1. 54; 95%可信区间，1.39-1.71）.结论和相关性研究结果表明，家庭成员中长期使用类阿片与接受手术和牙科手术的未使用类阿片的青少年和年轻人中持续使用类阿片有关。医生应筛查年轻患者的家庭是否长期使用阿片类药物，并加大力度预防有这一重要风险因素的患者对阿片类药物的依赖。
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.