By Emma Yasinski
A recent study published in JAMA Surgery suggests that teens and adolescents with family members who use opioids long-term are about twice as likely than those who don’t to refill their own opioid prescriptions written after common surgical procedures, including tooth extractions.
“In some situations, we may be able to avoid opioid prescribing, but in other situations we may still need to prescribe smaller quantities in order to adequately treat postoperative pain,” lead author, Calista Harbaugh MD, a general surgery resident at the University of Michigan, and a research fellow with The Michigan Opioid Prescribing Engagement Network (Michigan OPEN,) told Incisor. “It is our responsibility to understand the risk that we are providing to the patient and know when to monitor more closely for concerning patterns of opioid use.”
Previous studies have looked at a variety of factors that can predict a patient’s likelihood of developing persistent use at the individual level, such as mental health and history of substance use disorders. Rarely, however, have risk factors been assessed at the family or environmental level.
[See Incisor – August 17, 2018: Teeth Extractions May Set Young People on the Path to Long-Term Opioid Use – JAMA]
Dr. Harbaugh and her team of researchers used insurance claims to link the opioid prescriptions of family members. Romesh Nalliah, DDS, MHCM, a clinical associate professor at the University of Michigan who was not involved in the current study, but worked with the authors on a previous study, told Incisor: “Using insurance claims data is one of the few ways we can look at a larger slice of the profession and understand concepts like opioid prescribing.”
Harbaugh and Michigan OPEN made use of commercial insurance claims data to study the opioid prescription rates in patients aged 13 to 21 who had common surgeries or dental procedures between 2010 and 2016, and were considered opioid naïve, i.e., they had not received opioids in the 30 days prior to having surgery.
Then the researchers looked at how often these young patients refilled the initial prescription at different points in time, and whether there was an association between having a family member who had been using opioids long-term and the likelihood that the patient developed persistent opioid use. If the patient refilled the prescription 91-180 days after the procedure, the patient was considered to be a persistent user.
The study showed that patients who had a persistent opioid user in the family were more likely than those who did not to become persistent opioid users themselves. Of 11,016 patients, 4.3 percent of them had a family member who used opioids long-term. Of those patients, 453 – or 4.1 percent – had persistent opioid use, while only 2.4 percent of those without family members using opioids long-term showed persistent use.
“Long-term opioid use among family members is associated with increased opioid fills at all times points in the peri-procedural period among teens undergoing dental and surgical procedures,” said Dr. Harbaugh. “In particular, the rate of new persistent use nearly doubles among teens who have family members with long-term use.”
The authors suggest this could be due to a variety of factors, such as genetics or similar environmental exposures and attitudes toward opioid use.
Dr. Harbaugh cautioned that insurance data can’t capture the precise way in which an opioid prescription was used. For example, this study couldn’t measure whether a refilled prescription was misused or diverted to a family member.
Dr. Harbaugh hopes the study will help facilitate the creation of new, succinct screening tools. “Until then, screening should include questions about both patient factors, such as chronic pain disorders, depression, anxiety, and prior substance use disorder, and family factors such as opioid use among family members,” she said.
“If a patient is thought to be at elevated risk of persistent use, it is incumbent on the surgical provider to transition care to long-term providers who can monitor for future refill requests or signs of transition to misuse.”
[Editor’s Note: DOCS Education offer a comprehensive 3 CE credit online course that complies with the ADA’s call for every dentist to receive continuing education in prescribing opioids and other controlled substances. Designed exclusively for dentists, the course is taught by Leslie S.T. Fang, MD, PhD, who stresses ways to optimize the use of non-narcotic painkillers. To register, or for more information, visit here.]
Author: Contributing writer Emma Yasinski received her Master of Science (MS) in science and medical journalism from Boston University. Her articles have also appeared at TheAtlantic.com, Kaiser Health News, NPR Shots, and Genetic Engineering and Biotechnology News.
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