Prescribed opioids associated with overdose risk for family members without prescriptions

"When prescriptions are filled and there are extra pills in the medicine cabinet, family members with access to those medications could overdose or become dependent," said Joshua Gagne, PharmD, ScD, a pharmacoepidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics at the Brigham. "But few studies have systematically examined and quantified this risk."

The Brigham investigators drew from the health care utilization data from a large commercial insurance company in the United States, spanning 2004-2015. A total of 2,303 individuals who overdosed on opioids were matched with 9,212 controls, and all participants had no prior opioid prescriptions of their own. The investigators found that opioid dispensing to family members on the same health insurance plan was associated with a 2.89-fold increase in odds of an individual without a prescription overdosing. The association was present regardless of age; both children and adults were likelier to overdose if a family member had an opioid prescription.

The researchers looked exclusively at family members on the same health insurance plan. They acknowledged that they could not confirm whether the overdose was related to the family member's prescription or whether the opioids were obtained illicitly. In addition, they were unable to determine whether family members resided in the same household, which would have impacted the accessibility of the drugs.

The investigators hope that their findings can inform preventative strategies for combating opioid misuse. Interventions may focus on expanding access to opioid antagonists, safely storing prescription opioids in the home, and providing greater patient education to limit overdose among family members. In addition, they cited that opioid prescriptions should be limited to the number of pills a patient needs, reducing the number of excess drugs being available.

"Effective communication by physicians, pharmacists, nurses or public service announcements could increase awareness of opioids as a risk factor for family member overdose. Education is essential for reducing accidental exposure and misuse," said Gagne.

The study was funded internally by the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital. A co-author has received salary support from grants from GlaxoSmithKline and Pfizer.