EvidenceAlerts

Khan NF, Bateman BT, Landon JE, et al. Association of Opioid Overdose With Opioid Prescriptions to Family Members. JAMA Intern Med. 2019 Jun 24. pii: 2736355. doi: 10.1001/jamainternmed.2019.1064. (Original study)
Abstract

Importance: Prescription opioid misuse is a public health problem that leads to overdose. Although existing interventions focus on limiting prescribing to patients at high risk, individuals may still access prescription opioids dispensed to family members.

Objective: To determine whether opioid prescriptions to family members were associated with overdose for individuals who themselves did not have an opioid prescription.

Design, Setting, and Participants: We conducted a 1:4 matched case-control study using health care utilization data from 2004 through 2015 from a large US commercial insurance company. Eligible individuals were required to have at least 12 months of continuous enrollment and 1 or more family members in the database. Individuals who experienced overdose were identified by their first opioid overdose after the baseline period and matched to control participants by time in the database, calendar time, age, sex, and number of individuals in the family unit. Both groups were restricted to individuals with no prior opioid dispensing of their own. Data analysis was conducted from January 2018 to August 2018.

Exposures: Any prior opioid dispensing to a family member, total morphine milligram equivalents dispensed to family members, and the type of opioid product dispensed.

Main Outcomes and Measures: Individual odds of opioid overdose resulting in an emergency department visit or hospitalization were the primary end point. The primary analysis evaluated the odds of overdose among individuals whose family members had been dispensed an opioid. Sensitivity analyses examined the odds stratified by age and timing relative to the dispensing of opioids to family members.

Results: A total of 2303 individuals who experienced opioid overdose and 9212 matched control individuals were identified. The mean (SD) age was 23.2 (18.1) years; 1158 affected individuals and 4632 control individuals (50.3%) were female. The mean (SD) time in the database before an overdose case was 3.2 (3.3) years. Prior opioid dispensing to family members was associated with individual overdose (odds ratio [OR], 2.89 [95% CI, 2.59-3.23]). There was a significant dose-response association between increasing amounts of opioids dispensed to family members and odds of overdose (>0-<50 morphine milligram equivalents per day: OR, 2.71 [95% CI, 2.42-3.03]; 50-<90 morphine milligram equivalents per day: OR, 7.80 [95% CI, 3.63-16.78]; =90 morphine milligram equivalents per day: OR, 15.08 [95% CI, 8.66-26.27]).

Conclusions and Relevance: In this analysis, opioid prescriptions to family members were associated with overdose among individuals who do not receive opioid prescriptions. Interventions may focus on expanding access to opioid antagonists, locking prescription opioids in the home, and providing greater patient education to limit fatal overdose among family members.


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Ratings
Discipline Area Score
Special Interest - Pain -- Physician 6 / 7
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Public Health 5 / 7
Comments from MORE raters

General Internal Medicine-Primary Care(US) rater

While opioid misuse is an important issue, this study is not especially noteworthy, since the results are self-evident.

Special Interest - Pain -- Physician rater

No surprises here; households with opioids in them tend to have higher rates of overdoses. What they didn't calculate was the number needed to harm; according to my back-of-the-napkin calculation, the absolute risk is 7.1/100,000 for a NNH of 14,084. So the risk to the individual is exceedingly low, while the risk to society remains non-trivial but not as horrifying as the relative risks would suggest.

Special Interest - Pain -- Physician rater

It has been known for some time that increased doses of opioids correlates to increased overdose risk. However to my knowledge, there are limited data to show that increased doses of opioids increases risk to family members of overdose.
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