[Skip to Content]
[Skip to Content Landing]

Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults

Educational Objective To identify whether there is any association between long-term family member opioid use and persistent opioid use in adolescents and young adults postoperatively.
1 Credit CME
Key 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.

Sign in to take quiz and track your certificates

Buy This Activity
Article Information

Accepted for Publication: December 3, 2018.

Corresponding Author: Jennifer F. Waljee, MD, MPH, MS, Department of Surgery, University of Michigan Medical School, 1500 E Medical Center Dr, 2130 Taubman Center, Ann Arbor, MI 48109 (filip@med.umich.edu).

Published Online: February 27, 2019. doi:10.1001/jamasurg.2018.5838

Author Contributions: Drs Harbaugh and Waljee had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Ms Kenney conducted and is responsible for the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Harbaugh, Chua, Kenney, Iwashyna, Brummett, Waljee.

Drafting of the manuscript: Harbaugh, Chua, Brummett, Waljee.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Harbaugh, Chua, Kenney, Iwashyna.

Obtained funding: Brummett, Waljee.

Administrative, technical, or material support: Englesbe, Brummett, Waljee.

Supervision: Englesbe, Brummett, Waljee.

Conflict of Interest Disclosures: Dr Brummett reports a patent for peripheral perineural dexmedetomidine licensed to University of Michigan, being a paid consultant for Recro Pharma and Heron Therapeutics Inc (not related to the present work), and receiving research funding from Neuros Medical Inc. Dr Waljee reports receiving research funding from the Agency for Healthcare Research and Quality, the American College of Surgeons, and the American Foundation for Surgery of the Hand and serving as an unpaid consultant for 3M Health Information systems. No other disclosures were reported.

Funding/Support: This study was funded by grant E20180568-001 from the Substance Abuse and Mental Health Services Administration and grant E20180672-00 from the Centers for Medicare & Medicaid Services (Drs Englesbe, Brummett, and Waljee).

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of Substance Abuse and Mental Health Services Administration, the Michigan Department of Health and Human Services, the US government, or the US Department of Veterans Affairs.

References
1.
Gomes  T, Tadrous  M, Mamdani  MM, Paterson  JM, Juurlink  DN.  The burden of opioid-related mortality in the United States.  JAMA Netw Open. 2018;1(2):e180217. doi:10.1001/jamanetworkopen.2018.0217PubMedGoogle ScholarCrossref
2.
Seth  P, Scholl  L, Rudd  RA, Bacon  S.  Overdose deaths involving opioids, cocaine, and psychostimulants—United States, 2015-2016.  MMWR Morb Mortal Wkly Rep. 2018;67(12):349-358. doi:10.15585/mmwr.mm6712a1PubMedGoogle ScholarCrossref
3.
Groenewald  CB, Rabbitts  JA, Gebert  JT, Palermo  TM.  Trends in opioid prescriptions among children and adolescents in the United States: a nationally representative study from 1996 to 2012.  Pain. 2016;157(5):1021-1027. doi:10.1097/j.pain.0000000000000475PubMedGoogle ScholarCrossref
4.
Volkow  ND, McLellan  TA, Cotto  JH, Karithanom  M, Weiss  SR.  Characteristics of opioid prescriptions in 2009.  JAMA. 2011;305(13):1299-1301. doi:10.1001/jama.2011.401PubMedGoogle ScholarCrossref
5.
Harbaugh  CM, Lee  JS, Hu  HM,  et al.  Persistent opioid use among pediatric patients after surgery.  Pediatrics. 2018;141(1):e20172439. doi:10.1542/peds.2017-2439PubMedGoogle ScholarCrossref
6.
Bennett  KG, Harbaugh  CM, Hu  HM,  et al.  Persistent opioid use among children, adolescents, and young adults after common cleft operations.  J Craniofac Surg. 2018;29(7):1697-1701.PubMedGoogle Scholar
7.
Alam  A, Gomes  T, Zheng  H, Mamdani  MM, Juurlink  DN, Bell  CM.  Long-term analgesic use after low-risk surgery: a retrospective cohort study.  Arch Intern Med. 2012;172(5):425-430. doi:10.1001/archinternmed.2011.1827PubMedGoogle ScholarCrossref
8.
Brummett  CM, Waljee  JF, Goesling  J,  et al.  New persistent opioid use after minor and major surgical procedures in US adults.  JAMA Surg. 2017;152(6):e170504. doi:10.1001/jamasurg.2017.0504PubMedGoogle ScholarCrossref
9.
Clarke  H, Soneji  N, Ko  DT, Yun  L, Wijeysundera  DN.  Rates and risk factors for prolonged opioid use after major surgery: population based cohort study.  BMJ. 2014;348:g1251. doi:10.1136/bmj.g1251PubMedGoogle ScholarCrossref
10.
Sun  EC, Darnall  BD, Baker  LC, Mackey  S.  Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period.  JAMA Intern Med. 2016;176(9):1286-1293. doi:10.1001/jamainternmed.2016.3298PubMedGoogle ScholarCrossref
11.
Harbaugh  CM, Nalliah  RP, Hu  HM, Englesbe  MJ, Waljee  JF, Brummett  CM.  Persistent opioid use after wisdom tooth extraction.  JAMA. 2018;320(5):504-506. doi:10.1001/jama.2018.9023PubMedGoogle ScholarCrossref
12.
Elmallah  RK, Ramkumar  PN, Khlopas  A,  et al.  Postoperative pain and analgesia: is there a genetic basis to the opioid crisis?  Surg Technol Int. 2018;32:306-314.PubMedGoogle Scholar
13.
Mistry  CJ, Bawor  M, Desai  D, Marsh  DC, Samaan  Z.  Genetics of opioid dependence: a review of the genetic contribution to opioid dependence.  Curr Psychiatry Rev. 2014;10(2):156-167. doi:10.2174/1573400510666140320000928PubMedGoogle ScholarCrossref
14.
Angst  MS, Phillips  NG, Drover  DR,  et al.  Pain sensitivity and opioid analgesia: a pharmacogenomic twin study.  Pain. 2012;153(7):1397-1409. doi:10.1016/j.pain.2012.02.022PubMedGoogle ScholarCrossref
15.
Nielsen  CS, Knudsen  GP, Steingrímsdóttir  ÓA.  Twin studies of pain.  Clin Genet. 2012;82(4):331-340. doi:10.1111/j.1399-0004.2012.01938.xPubMedGoogle ScholarCrossref
16.
Pestka  EL, Craner  J, Evans  M,  et al.  Impact of family history of substance abuse on admission opioid dose, depressive symptoms, and pain catastrophizing in patients with chronic pain.  Pain Manag Nurs. 2018;19(2):115-124. doi:10.1016/j.pmn.2017.09.007PubMedGoogle ScholarCrossref
17.
Merikangas  KR, Stolar  M, Stevens  DE,  et al.  Familial transmission of substance use disorders.  Arch Gen Psychiatry. 1998;55(11):973-979. doi:10.1001/archpsyc.55.11.973PubMedGoogle ScholarCrossref
18.
Voepel-Lewis  T, Zikmund-Fisher  BJ, Smith  EL, Zyzanski  S, Tait  AR.  Parents’ preferences strongly influence their decisions to withhold prescribed opioids when faced with analgesic trade-off dilemmas for children: a prospective observational study.  Int J Nurs Stud. 2015;52(8):1343-1353. doi:10.1016/j.ijnurstu.2015.05.003PubMedGoogle ScholarCrossref
19.
Seamans  MJ, Carey  TS, Westreich  DJ,  et al.  Association of household opioid availability and prescription opioid initiation among household members.  JAMA Intern Med. 2018;178(1):102-109. doi:10.1001/jamainternmed.2017.7280PubMedGoogle ScholarCrossref
20.
Hansen  L. The Truven Health MarketScan Databases for life sciences researchers. http://content.truvenhealth.com/rs/699-YLV-293/images/2017%20MarketScan%20Databases%20for%20Life%20Sciences%20Researchers%20WP.pdf?aliId=4361930. Published 2017. Accessed September 18, 2018.
21.
Nasseh  K, Vujicic  M, Glick  M.  The relationship between periodontal interventions and healthcare costs and utilization: evidence from an integrated dental, medical, and pharmacy commercial claims database.  Health Econ. 2017;26(4):519-527. doi:10.1002/hec.3316PubMedGoogle ScholarCrossref
22.
Vandenbroucke  JP, von Elm  E, Altman  DG,  et al; STROBE Initiative.  Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.  PLoS Med. 2007;4(10):e297. doi:10.1371/journal.pmed.0040297PubMedGoogle ScholarCrossref
23.
Feudtner  C, Feinstein  JA, Zhong  W, Hall  M, Dai  D.  Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation.  BMC Pediatr. 2014;14:199. doi:10.1186/1471-2431-14-199PubMedGoogle ScholarCrossref
24.
International Association for the Study of Pain. IASP Task Force for the Classification of Chronic Pain in ICD-11 prepares new criteria on postsurgical and posttraumatic pain. https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=4611. Accessed March 18, 2017.
25.
Lee  JS, Hu  HM, Edelman  AL,  et al.  New persistent opioid use among patients with cancer after curative-intent surgery.  J Clin Oncol. 2017;35(36):4042-4049. doi:10.1200/JCO.2017.74.1363PubMedGoogle ScholarCrossref
26.
Bohnert  AS, Ilgen  MA, Trafton  JA,  et al.  Trends and regional variation in opioid overdose mortality among Veterans Health Administration patients, fiscal year 2001 to 2009.  Clin J Pain. 2014;30(7):605-612.PubMedGoogle Scholar
27.
Centers for Disease Control, US Department of Health and Human Services. Calculating total daily dose of opioids for safer dosage. https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf. Accessed September 18, 2018.
28.
Meier  MH, Hall  W, Caspi  A,  et al.  Which adolescents develop persistent substance dependence in adulthood? using population-representative longitudinal data to inform universal risk assessment.  Psychol Med. 2016;46(4):877-889. doi:10.1017/S0033291715002482PubMedGoogle ScholarCrossref
29.
Cambron  C, Kosterman  R, Catalano  RF, Guttmannova  K, Hawkins  JD.  Neighborhood, family, and peer factors associated with early adolescent smoking and alcohol use.  J Youth Adolesc. 2018;47(2):369-382. doi:10.1007/s10964-017-0728-yPubMedGoogle ScholarCrossref
30.
Ozechowski  TJ, Becker  SJ, Hogue  A.  SBIRT-A: adapting SBIRT to maximize developmental fit for adolescents in primary care.  J Subst Abuse Treat. 2016;62:28-37. doi:10.1016/j.jsat.2015.10.006PubMedGoogle ScholarCrossref
31.
Park  M, Giap  TT, Lee  M, Jeong  H, Jeong  M, Go  Y.  Patient- and family-centered care interventions for improving the quality of health care: a review of systematic reviews.  Int J Nurs Stud. 2018;87:69-83. doi:10.1016/j.ijnurstu.2018.07.006PubMedGoogle ScholarCrossref
32.
Palamar  JJ, Shearston  JA, Cleland  CM.  Discordant reporting of nonmedical opioid use in a nationally representative sample of US high school seniors.  Am J Drug Alcohol Abuse. 2016;42(5):530-538. doi:10.1080/00952990.2016.1178269PubMedGoogle ScholarCrossref
33.
Morris  C, Green  KE, Chimuma  LL.  A Rasch analysis of the Current Opioid Misuse Measure for patients with chronic pain.  J Opioid Manag. 2018;14(1):9-14. doi:10.5055/jom.2018.0424PubMedGoogle ScholarCrossref
34.
Webster  LR, Webster  RM.  Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the opioid risk tool.  Pain Med. 2005;6(6):432-442. doi:10.1111/j.1526-4637.2005.00072.xPubMedGoogle ScholarCrossref
35.
Botticelli  MP, Koh  HK.  Changing the language of addiction.  JAMA. 2016;316(13):1361-1362. doi:10.1001/jama.2016.11874PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Topics
State Requirements