Anh P. Nguyen, PhD, on How Family Exposure Affects Youth Opioid Overdose Risk

In a recent study published in JAMA Network Open, researchers found that youth with family members who are prescribed opioids are at an increased risk of opioid overdose, whether or not the youth are prescribed opioids themselves.

The findings were based on the results of a cohort study of 45,145 families including 72,040 adolescents and young adults aged 11 to 26 years. Using electronic health records from families enrolled in Kaiser Permanente Colorado health plans, the researchers recorded youth overdoses as well as opioid prescriptions and dosages dispensed to family members in each month during the study period.

They found that while youth were more likely to have exposure to opioids through family member prescriptions rather than through opioids prescribed to themselves, that exposure was linked to an increased risk of pharmaceutical opioid overdose (adjusted hazard ratio [aHR] 2.17 95% CI, 1.24-3.79) independent of their prescriptions. Additionally, concurrent exposure from their own prescription and a family member was associated with significantly increased overdose risk (aHR, 12.99; 95% CI, 5.08-33.25).

Consultant360 reached out to lead study author Anh P. Nguyen, PhD, from the Kaiser Permanente Colorado Institute for Health Research, to discuss the study further.

Consultant360: Why did you decide to focus your study on the risk of overdose among youth with family members who were prescribed opioids?

Anh P Nguyen, PhD: There is growing evidence to suggest that the family environment has an important role in opioid use and misuse among young people. Yet, it has not been well-established whether exposure to prescription opioids from family members is associated with overdose risk among youth. We sought to directly test this association in our study by leveraging data on opioid prescribing and overdose outcomes in a large cohort of families.
C360: You found that concurrent exposure to opioid prescriptions from both youth and family members was linked to significantly higher overdose risk. Why do you think this is?

APN: While concurrent exposure to opioid prescriptions from youth and family members is uncommon, the strength of association with overdose is quite remarkable. There are several plausible explanations for such significantly higher overdose risk: (1) Having multiple prescriptions for more than one family member increases the amount of opioids in the home that may be taken accidentally or intentionally misused; (2) concurrent exposure may be a marker for health-related risk factors of opioid misuse shared among family members; and (3) concurrent exposure may also reflect exposure to social stressors, such as financial insecurity, in families that may be linked to opioid misuse.
C360: How do you think your findings add to the growing body of evidence of the dangers of opioid overuse?

APN: Our study demonstrates that prescription opioids from family members pose significant health risks to young people, if taken accidentally or intentionally misused. It suggests that interventions to prevent overdoses should focus not only on individuals but also families as a whole.
C360: Are there any knowledge gaps that still exist in this area? If so, what should future studies focus on?

APN: Future research should disentangle potential mechanisms that could explain the association of prescribed opioids from family members with overdose among young people, including access to opioids in the home, normalization of behaviors and attitudes regarding use and misuse of opioids, and shared risk factors that link patterns of opioid use among family members. Moreover, more work is needed to assess the effectiveness of interventions aimed at the family-level to prevent overdoses.

Nguyen AP, Glanz JM, Narwaney KJ, et al. Association of opioids prescribed to family members with opioid overdose among adolescents and young adults [published online March 27, 2020]. JAMA Netw Open. 2020;3(3):e201018. doi:10.1001/jamanetworkopen.2020.1018