Institute for Health Research, Kaiser Permanente Colorado, Aurora.
Department of Epidemiology, Colorado School of Public Health, Aurora.
JAMA Netw Open. 2020 Mar 2;3(3):e201018. doi: 10.1001/jamanetworkopen.2020.1018.
Family members are cited as a common source of prescription opioids used for nonmedical reasons. However, the overdose risk associated with exposure to opioids prescribed to family members among adolescents and young adults is not well established.
To assess the association of opioids prescribed to family members with pharmaceutical opioid overdose among youth.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 45 145 family units with a total of 72 040 adolescents and young adults aged 11 to 26 years enrolled in a Kaiser Permanente Colorado health plan in 2006 and observed through June 2018.
Opioid prescriptions and dosage dispensed to family members and youth in the past month.
Fatal pharmaceutical opioid overdoses identified in vital records and nonfatal pharmaceutical opioid overdoses identified in emergency department and inpatient settings. Time to first overdose was modeled using Cox regression.
The study population consisted of 72 040 adolescents and young adults (mean [SD] age across follow-up, 19.3 [3.7] years; 36 646 [50.9%] girls and women) nested in 45 145 family units. Youth were more commonly exposed to prescription opioids dispensed to a family member than through their own prescriptions. During follow-up, 26 284 youth (36.5%) filled at least 1 opioid prescription, and 47 461 youth (65.9%) had at least 1 family member with a prescription. Exposure to family members with opioid prescriptions in the past month was associated with increased risk of pharmaceutical opioid overdose (adjusted hazard ratio [aHR], 2.17; 95% CI, 1.24-3.79) independent of opioids prescribed to youth (aHR, 6.62; 95% CI, 3.39-12.91). Concurrent exposure to opioid prescriptions from youth and family members was associated with substantially increased overdose risk (aHR, 12.99; 95% CI, 5.08-33.25). High dosage of total morphine milligram equivalents (MME) prescribed to family members in the past month was associated with youth overdose (0 MME vs >0 to <200 MME: aHR, 1.39; 95% CI, 0.51-3.81; 0 MME vs 200 to <600 MME: aHR, 1.49; 95% CI, 0.59-3.77; 0 MME vs ≥600 MME: aHR, 2.93; 95% CI, 1.55-5.56).
In this study of youth linked to family members, exposure to family members' prescribed opioids was associated with increased risk of pharmaceutical opioid overdose, independent of opioids prescribed to youth. Further interventions targeting youth and families are needed, including counseling patients about the risks of opioids to youth in their families.
家庭成员被认为是出于非医疗原因使用处方类阿片的常见来源。然而，青少年和年轻人接触到家庭成员开的阿片类药物与药物过量的风险尚未得到充分证实。
评估开给家庭成员的阿片类药物与青少年药物过量之间的关联。
设计、地点和参与者：这项队列研究纳入了科罗拉多州 Kaiser Permanente 健康计划中的 45145 个有总共 72040 名年龄在 11 至 26 岁之间的青少年和年轻人的家庭单位，从 2006 年开始随访至 2018 年 6 月。
过去一个月内开给家庭成员和青少年的阿片类药物处方和剂量。
在生命记录中确定了致命的药物类阿片类药物过量，在急诊和住院环境中确定了非致命的药物类阿片类药物过量。使用 Cox 回归模型来计算首次药物过量的时间。
该研究人群包括 72040 名青少年和年轻人（整个随访期间的平均年龄[标准差]为 19.3[3.7]岁；36646 名[50.9%]女孩和女性）嵌套在 45145 个家庭单位中。与自身的处方相比，青少年更常接触到开给家庭成员的处方类阿片类药物。在随访期间，26284 名青少年（36.5%）至少开了 1 次阿片类药物处方，47461 名青少年（65.9%）至少有 1 名家庭成员有处方。过去一个月接触有阿片类药物处方的家庭成员与药物类阿片类药物过量的风险增加相关（调整后的危险比[aHR]，2.17；95%CI，1.24-3.79），而与开给青少年的阿片类药物无关（aHR，6.62；95%CI，3.39-12.91）。同时接触青少年和家庭成员的阿片类药物处方与药物过量风险显著增加相关（aHR，12.99；95%CI，5.08-33.25）。过去一个月家庭成员开给的总吗啡毫克当量（MME）高与青少年药物过量有关（0 MME 比>0 至<200 MME：aHR，1.39；95%CI，0.51-3.81；0 MME 比 200 至<600 MME：aHR，1.49；95%CI，0.59-3.77；0 MME 比≥600 MME：aHR，2.93；95%CI，1.55-5.56）。
在这项对与家庭成员相关的青少年的研究中，接触家庭成员开的阿片类药物与药物类阿片类药物过量的风险增加有关，而与开给青少年的阿片类药物无关。需要进一步针对青少年和家庭的干预措施，包括向家庭成员中的青少年患者提供有关阿片类药物风险的咨询。
