Opioid use in the family may influence adolescents' opioid risk after surgery

The presence of one or more family members using long-term opioids before a procedure was associated with a higher likelihood that adolescents prescribed opioids for the first time would do the same, according to the findings. The research, led by surgery and pediatric teams at University of Michigan C.S. Mott Children's Hospital, appeared today in JAMA Surgery.

"We know from previous research that adolescents and young adults undergoing dental and other common surgical procedures are at risk of persistent opioid use after their first opioid prescription," says senior author Jennifer Waljee, M.D., Michigan Medicine and Mott surgeon and member of the Michigan Opioid Prescribing Engagement Network (Michigan-OPEN) at the Institute for Healthcare Policy and Innovation.

"Our study suggests a potential relationship between this risk among youth and the presence of opioid use among family members and may be an important consideration when screening for individuals at risk for prolonged postoperative opioid use."

The observational study used data from a commercial insurance database for about 346,000 patients ages 13 to 21 who underwent such procedures as wisdom tooth extraction, appendix removal, hernia repair, and knee and shoulder surgery. The data included dependents on a family insurance plan between 2010 and 2016.

Among the 257,000 (74 percent) of patients who had their first-ever opioid prescription filled, about 11,000 (4.3 percent) had one or more family member with long term opioid use. These included family members who had filled opioid prescriptions 120 or more days during the 12 months before the young person's procedure or filled three or more opioid prescriptions within 90 days.

Persistent opioid use (one or more opioid prescriptions filled three or more months after surgery) occurred in 453 patients (4.1 percent) with a family member who was a long-term user of opioids compared with 5,940 patients (2.4 percent) without long-term opioid use by a family member.

Authors note that the research cannot explain whether the association is because of genetic reasons, parenting behaviors, or even use of the opioid prescription by someone else in the family. The study also included patients with private employer-based insurance so the findings may not be generalized to patients who are publicly insured or uninsured.

Still, the research raises concern about the risk that young adults continue opioid prescription refills long after common dental or surgical procedures, says lead author Calista Harbaugh, M.D., a pediatric surgery researcher at Mott and member of Michigan-OPEN. Chronic opioid use can result in addiction, overdose or even death.

Harbaugh says providers should discuss the potential harms of continued opioid use with families and provide help for patients still seeking refills three or more months after a procedure.

"We are trying to better understand what impacts a young adult's risk of chronic opioid use after the first time they are prescribed an opioid," Harbaugh says. "Surgeons and providers should heighten efforts to prevent opioid dependence among patients with any potential risk factors."