Household prescription opioid exposure linked to small increased risk of opioid initiation

1. Household member opioid prescription was linked to a small increase in the risk of personal opioid prescription compared to a household non-steroidal anti-inflammatory (NSAID) prescription.

2. The observed association may be explained by an unaccounted variable that is moderately associated with the exposure and outcome.

Evidence Rating Level: 2 (Good)

Study Rundown: Opioid use is increasing in the United States along with addiction, toxicity, overdoses, and accidental ingestions. Prescription opioid prescribing patters can influence the risk of developing opioid use disorders. Sharing of home supply of prescriptions is common amongst family and other household members. The current study sought to compare the risk of a new opioid prescription for an individual with exposure to a household member receiving an opioid or NSAID prescription. The exposure to a household opioid prescription was linked to a small increase in absolute risk of new opioid prescription compared to a household NSAID prescription.

The study highlights the important impact of household prescriptions on risk of new opioid prescriptions. Although the absolute increased risk was small, the prevalence of opioid prescriptions means that this may have important influences on a population scale. The study had a large size and effective comparison to a non-opioid pain medication prescription. The main limitations of the study include the inability to confirm co-residence, the possibility of other sources of opioids from other household members with alternative insurance, and the inability to account for possible confounders such as shared primary care providers with bias towards certain prescribing patters.

Click to read the study, published in JAMA Internal Medicine

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In-Depth [retrospective cohort]: This study used data from the 2000-2014 Truven Health Analytics MarketScan Commercial Claims and Encounters databases and formed a retrospective cohort of household members who initiated opioid or NSAID prescriptions based on outpatient pharmacy dispensing claims. New use was considered the first prescription within 365 days of active enrollment without evidence of prior claims. Household members were excluded if the index patient had a history of malignant neoplasm, hospice services, or initiated NSAID and opioid prescriptions simultaneously. Covariates accounted for the analysis included: geographic location, household size, children in household, year of cohort entry, and prior history of substance use.

During the study period, participants were exposed to 12 695 280 household opioid prescriptions, and 6 359 639 NSAID prescriptions. The risk of new opioid prescription during the following year was 11.83% (95%CI, 11.81%-11.85%) for opioid exposed individuals and 11.11% (95%CI, 11.09%-11.14%) in the NSAID group. The absolute risk difference of 0.71% could be explained by a confounder that is moderately associated with the exposure and outcome.

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