1. In this case-control study in the US, opioid overdoses were associated with history of opioid prescription to a family member, with a dose-response association.
2. The association was largely driven by opioid overdoses in children.
Evidence Rating Level: 3 (Average)
Study Rundown: Opioid overdoses are a rising concern in North America and are responsible for tens of thousands of deaths annually. This was a case-control study using data from a large American insurance company. The study found that among patients with no prior opioid prescriptions themselves, risk of opioid overdose was significantly higher when a family member (defined as someone under the same health plan) had an opioid prescription. This effect was driven largely by opioid overdoses in children ages 0-18, however a modest effect persisted in adults. The association increased with increasing amount of opioid prescribed daily.
Limitations of the study included the case-control methodology, inability to confirm whether family members lived in one household, and inability to capture family members under separate health care plans. Despite these, this study further supports educating patients about safe handling and storage of opioids, and increased access to opioid reversal kits.
In-Depth [case-control study]: This was a nested case-control study with cases (opioid overdoses) matched 1:4 with controls. Data was collected from patients enrolled for at least one year in a large commercial American insurance company with at least one family member also enrolled. Both case and control patients could not have any prior opioid prescriptions of their own. Family members were defined as others enrolled under the same health care plan. Control patients were matched based on age, gender, time in database, calendar time, and number of individuals on same health care plan. Opioid overdose was defined as first emergency department visit or hospitalization for opioid overdose. Total dosage of opioids prescribed to family members was grouped based on Morphine Milligram Equivalents (MME) as 0-50 MME, 50-90 MME, or >90 MME daily. Results were controlled for major comorbidities and other medication use.
There were 2303 individuals affected by opioid overdose and were matched 1:4 with 9212 control patients. Mean age of all patients was 23.2 and 50.3% were female. Baseline opioid overdose rate among controls was 3.8 events per 100,000 person-years. Any prior opioid prescription to a family member was associated with increased risk of opioid overdose [odds ratio (OR) 2.89, 95% CI 2.59-3.23]. There was a dose-response association based on daily MME as follows: daily MME 0-50 had OR 2.71 (95% CI 2.42-3.03), daily MME 50-90 had OR 7.80 (95% CI 3.63-16.78), and daily MME >90 had OR 15.08 (95% CI 8.66-26.27). Age stratified analysis yielded significant differences depending on age group. For patients age 0-6, OR was 4.08 (95% CI 3.07-5.41); for patients age 7-12, OR 4.38 (95% CI 3.07-6.26); for patients age 13-18, OR 3.38 (95% CI 2.78-4.11); for patients age 19-34, OR 1.78 (95% CI 1.33-2.38); for patients age 35-59, OR 2.28 (95% CI 1.77-2.96); and for patients age 60+, OR 1.80 (95% CI 0.96-3.37).
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