Comment; no surprises here; family history of opioid abuse implying that the genes for addiction are in the patient is linked with double the rate of addictive use after exposure of an opioid-naive patient to the first doses of opioids
Calista M. Harbaugh, MD1,2; Jay S. Lee, MD2; Kao-Ping Chua, MD, PhD3; et alBrooke Kenney, MPH4; Theodore John Iwashyna, MD, PhD5,6; Michael J. Englesbe, MD2; Chad M. Brummett, MD7; Amy S. Bohnert, PhD6,8; Jennifer F. Waljee, MD, MPH, MS2Author AffiliationsJAMA Surg. Published online February 27, 2019. doi:10.1001/jamasurg.2018.5838editorial comment icon EditorialComment
FullTextKey Points
Question Is long-term opioid use among family members associated with persistent opioid use among opioid-naive adolescents and young adults undergoing surgical and dental procedures?
Findings In this cohort study of 346 251 opioid-naive individuals aged 13 to 21 years undergoing common surgical and dental procedures with an initial opioid prescription fill, persistent opioid use occurred in 453 patients (4.1%) with long-term opioid use in family members compared with 5940 patients (2.4%) without long-term opioid use in family members.
Meaning 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 surgery and should be screened for in the preoperative period.Abstract
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.
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