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Citation
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Hadland SE, Bagley SM, Gai MJ, Earlywine JJ, Schoenberger SF, Morgan JR, Barocas JA. Addiction 2021; ePub(ePub): ePub. |
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Abstract
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BACKGROUND AND AIMS: Some adolescents and young adults (termed 'youth') prescribed an opioid will develop opioid use disorder or experience overdose. This study aimed to identify patient and prescription characteristics associated with subsequent risk of opioid use disorder or overdose during the year after an opioid is first dispensed.
DESIGN: Retrospective cohort study. SETTING: Commercial health insurance claims in a large US database from 2006 to 2016. PARTICIPANTS: Youth aged 11-25 years filling an initial opioid prescription (n=3,278,990). MEASUREMENTS: The primary outcome was development of an 'opioid-related complication' (a diagnosis of opioid use disorder or opioid-related overdose) during the subsequent 12 months. Exposures of interest were patient (sociodemographic information, and physical and mental health diagnoses) and prescription characteristics (opioid formulation, dose, and duration).
FINDINGS: Among youth filling an initial opioid prescription, median age was 18 years (IQR, 16-21) and 56.1% were female. During the subsequent 12 months, 10,405 (0.3%) youth experienced an opioid-related complication. Conditions associated with increased risk included mood/anxiety disorders (aRR, 4.45 [95% CI, 4.25-4.66]) and substance use (aRR, 20.77 [95% CI, 19.74-21.84]). Comorbid substance use disorders were present among 72.8% of youth experiencing an opioid-related complication and included alcohol (33.4%), cannabis (33.0%), nicotine (43.2%), and other substance use disorders (75.5%). Long-acting opioids (aRR, 2.59 [95% CI, 2.18-3.09]) and longer durations were associated with increased risk (7-14 days: aRR, 1.15 [95% CI, 1.08-1.22]; ≥15 days: aRR, 1.96 [95% CI, 1.80-2.12]) compared with short-acting formulations and durations ≤3 days, respectively.
CONCLUSIONS: Among US youth, complications after an initial opioid prescription appear to be relatively rare and appear to be associated with mood/anxiety disorders, substance use, comorbid substance use disorders, and prescriptions involving long-acting opioids or long durations.
Language: en |