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Surgery

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

JAMA Surgery

April 17, 2019

Original Investigation

Article Information and Disclosures

Calista M. Harbaugh, MD^1,2;

Jay S. Lee, MD²;

Kao-Ping Chua, MD, PhD³;

et al

Brooke Kenney, MPH⁴;

Theodore John Iwashyna, MD, PhD^5,6;

Michael J. Englesbe, MD²;

Chad M. Brummett, MD⁷;

Amy S. Bohnert, PhD^6,8;

Jennifer F. Waljee, MD, MPH, MS²

Author Affiliations

¹National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
²Department of Surgery, University of Michigan Medical School, Ann Arbor
³Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
⁴Michigan Opioid Prescribing Engagement Network, Ann Arbor
⁵Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
⁶Veterans Affairs (VA) Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan
⁷Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
⁸Department of Psychiatry, University of Michigan Medical School, Ann Arbor

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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.

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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.

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

Caution in the Postoperative Treatment of Pain With Opioids—Surgeon Awareness Needed

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