Association of Opioids Prescribed to Family Members With Opioid Overdose Among Adolescents and Young Adults
Association of Opioids Prescribed to Family Members With Opioid Overdose Among Adolescents and Young Adults
复制标题
DOI：
10.1001/jamanetworkopen.2020.1018
复制
发表时间：
2020-03-27
影响因子：
13.8
通讯作者：
Binswanger, Ingrid A.
中科院分区：
文献类型：
--
作者：
Nguyen, Anh P.;Glanz, Jason M.;Binswanger, Ingrid A.
重要性家庭成员被认为是用于非医疗原因的处方阿片类药物的常见来源。然而，与青少年和年轻人家庭成员处方阿片类药物接触相关的过量风险尚未很好地确定。目的评估向家庭成员开出的阿片类药物与年轻人药物性阿片类药物过量的相关性。设计、环境和参与者这项队列研究包括45 145个家庭单位，总共72 040名11至26岁的青少年和年轻人，于2006年登记在科罗拉多州凯撒永久健康计划中，观察到2018年6月。暴露过去一个月向家庭成员和青少年分配的阿片类药物处方和剂量。在急诊科和住院患者环境中发现的重要记录中发现的致命阿片类药物过量和非致命性阿片类药物过量的主要结果和措施。结果研究人群包括72040名青少年和青壮年(平均随访年龄19.3[3.7]岁；36646名(50.9%)女孩和妇女)嵌套在45145个家庭单元中。年轻人更容易接触到分发给家庭成员的处方阿片类药物，而不是通过他们自己的处方。在随访期间，26284名青年(36.5%)至少开了一张阿片类药物处方，47461名青年(65.9%)至少有一名家庭成员开了处方。过去一个月接触有阿片类药物处方的家庭成员与药物过量阿片类药物过量的风险增加(调整后的危险比[AHR]，2.17；95%CI，1.24-3.79)无关(AHR，6.62；95%CI，3.39-12.91)。同时接触年轻人和家庭成员的阿片类药物处方与过量服药风险显著增加相关(AHR，12.99；95%CI，5.08-33.25)。过去一个月给家庭成员开的高剂量总吗啡毫克当量(MME)与青少年过量用药有关(0毫克对0至
Importance Family members are cited as a common source of prescription opioids used for nonmedical reasons. However, the overdose risk associated with exposure to opioids prescribed to family members among adolescents and young adults is not well established.Objective To assess the association of opioids prescribed to family members with pharmaceutical opioid overdose among youth.Design, Setting, and Participants This cohort study included 45 145 family units with a total of 72 040 adolescents and young adults aged 11 to 26 years enrolled in a Kaiser Permanente Colorado health plan in 2006 and observed through June 2018.Exposures Opioid prescriptions and dosage dispensed to family members and youth in the past month.Main Outcomes and Measures Fatal pharmaceutical opioid overdoses identified in vital records and nonfatal pharmaceutical opioid overdoses identified in emergency department and inpatient settings. Time to first overdose was modeled using Cox regression.Results The study population consisted of 72 040 adolescents and young adults (mean [SD] age across follow-up, 19.3 [3.7] years; 36 646 [50.9%] girls and women) nested in 45 145 family units. Youth were more commonly exposed to prescription opioids dispensed to a family member than through their own prescriptions. During follow-up, 26 284 youth (36.5%) filled at least 1 opioid prescription, and 47 461 youth (65.9%) had at least 1 family member with a prescription. Exposure to family members with opioid prescriptions in the past month was associated with increased risk of pharmaceutical opioid overdose (adjusted hazard ratio [aHR], 2.17; 95% CI, 1.24-3.79) independent of opioids prescribed to youth (aHR, 6.62; 95% CI, 3.39-12.91). Concurrent exposure to opioid prescriptions from youth and family members was associated with substantially increased overdose risk (aHR, 12.99; 95% CI, 5.08-33.25). High dosage of total morphine milligram equivalents (MME) prescribed to family members in the past month was associated with youth overdose (0 MME vs >0 to