Division of Research and Evaluation, Comagine Health, Portland, Oregon.
School of Public Health, Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas.
JAMA Netw Open. 2023 Mar 1;6(3):e233385. doi: 10.1001/jamanetworkopen.2023.3385.
Previous studies that examined the role of household opioid prescriptions in opioid overdose risk were limited to commercial claims, did not include fatal overdoses, and had limited inclusion of household prescription characteristics. Broader research is needed to expand understanding of the risk of overdose.
To assess the role of household opioid availability and other household prescription factors associated with individuals' odds of fatal or nonfatal opioid overdose.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study assessing patient outcomes from January 1, 2015, through December 31, 2018, was conducted on adults in the Oregon Comprehensive Opioid Risk Registry database in households of at least 2 members. Data analysis was performed between October 16, 2020, and January 26, 2023.
Household opioid prescription availability and household prescription characteristics.
Opioid overdoses were captured from insurance claims, death records, and hospital discharge data. Household opioid prescription availability and prescription characteristics for individuals and households were modeled as 6-month cumulative time-dependent measures, updated monthly. To assess the association between household prescription availability, household prescription characteristics, and overdose, multilevel logistic regression models were developed, adjusting for demographic, clinical, household, and prescription characteristics.
The sample included 1 691 856 individuals in 1 187 140 households, of which most were women (53.2%), White race (70.7%), living in metropolitan areas (75.8%), and having commercial insurance (51.8%), no Elixhauser comorbidities (69.5%), and no opioid prescription fills in the study period (57.0%). A total of 28 747 opioid overdose events were observed during the study period (0.0526 per 100 person-months). Relative to individuals without personal or household opioid fills, the odds of opioid-related overdose increased by 60% when another household member had an opioid fill in the past 6 months (adjusted odds ratio [aOR], 1.60; 95% CI, 1.54-1.66) and were highest when both the individual and another household member had opioid fills in the preceding 6 months (aOR, 6.25; 95% CI, 6.09-6.40).
In this cohort study of adult Oregon residents in households of at least 2 members, the findings suggest that household prescription availability is associated with increased odds of opioid overdose for others in the household, even if they do not have their own opioid prescription. These findings underscore the importance of educating patients about proper opioid disposal and the risks of household opioids.
先前研究家庭阿片类药物处方在阿片类药物过量风险中的作用，仅限于商业索赔，不包括致命性过量，并且对家庭处方特征的纳入有限。需要更广泛的研究来扩大对过量风险的理解。
评估家庭阿片类药物的可获得性和其他家庭处方因素与个体致命或非致命阿片类药物过量的几率之间的关系。
设计、设置和参与者：这是一项回顾性队列研究，评估了 2015 年 1 月 1 日至 2018 年 12 月 31 日期间，俄勒冈综合阿片类药物风险登记处数据库中至少有 2 名成员的家庭中成年人的患者结局。数据分析于 2020 年 10 月 16 日至 2023 年 1 月 26 日进行。
家庭阿片类药物处方的可获得性和家庭处方特征。
从保险索赔、死亡记录和医院出院数据中捕获阿片类药物过量。个人和家庭的家庭阿片类药物处方的可获得性和处方特征被建模为 6 个月的累积时间依赖性措施，每月更新。为了评估家庭处方可获得性、家庭处方特征与过量之间的关联，开发了多水平逻辑回归模型，调整了人口统计学、临床、家庭和处方特征。
该样本包括 1691856 名个人和 1187140 个家庭，其中大多数是女性（53.2%）、白人（70.7%）、居住在大都市区（75.8%）和拥有商业保险（51.8%），无 Elixhauser 合并症（69.5%），且在研究期间无阿片类药物处方（57.0%）。在研究期间共观察到 28747 例阿片类药物过量事件（每 100 人月 0.0526 例）。与没有个人或家庭阿片类药物使用的个体相比，当另一名家庭成员在过去 6 个月中有阿片类药物使用时，与阿片类药物相关的过量的几率增加了 60%（调整后的优势比 [aOR]，1.60；95%CI，1.54-1.66），当个体和另一名家庭成员在前 6 个月都有阿片类药物使用时，几率最高（aOR，6.25；95%CI，6.09-6.40）。
在这项针对俄勒冈州至少有 2 名成员的家庭中的成年居民的队列研究中，研究结果表明，家庭处方的可获得性与家庭中其他人的阿片类药物过量几率增加有关，即使他们自己没有阿片类药物处方。这些发现强调了教育患者正确处理阿片类药物和家庭阿片类药物风险的重要性。
Zotero 插件