Association of Postsurgical Opioid Refills for Patients With Risk of Opioid Misuse and Chronic Opioid Use Among Family Members.
Association of Postsurgical Opioid Refills for Patients With Risk of Opioid Misuse and Chronic Opioid Use Among Family Members.
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DOI：
10.1001/jamanetworkopen.2022.21316
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发表时间：
2022-07-01
影响因子：
13.8
通讯作者：
Kohane, Isaac
中科院分区：
文献类型：
--
作者：
Agniel, Denis;Brat, Gabriel A.;Marwaha, Jayson S.;Fox, Kathe;Knecht, Daniel;Paz, Harold L.;Bicket, Mark C.;Yorkgitis, Brian;Palmer, Nathan;Kohane, Isaac
This cohort study examines the association between the receipt of opioid prescriptions after surgery and the risk of opioid misuse and chronic opioid use among family members of the patient. What is the association between a patient’s new opioid exposure after hospital discharge and subsequent opioid misuse and chronic opioid use in family members in the same household? In this cohort study of 843 531 patient and family member pairs, each additional opioid prescription refill for the patients was associated with increased hazard of opioid misuse among family members in adjusted models. The risk of opioid misuse and chronic opioid use increased in households in which the patient obtained refills. Findings of this study suggest that family members in a household with a patient who received opioid prescription refills may have an increased risk of opioid misuse and chronic opioid use. 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. 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. 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. Duration of opioid exposure and refills of opioid prescriptions received by patients after surgery. Risk of opioid misuse and chronic opioid use in family members were calculated using inverse probability weighted Cox proportional hazards regression models. 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. 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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