TY - JOUR
T1 - Association of household opioid availability and prescription opioid initiation among household members
AU - Seamans, Marissa J.
AU - Carey, Timothy S.
AU - Westreich, Daniel J.
AU - Cole, Stephen R.
AU - Wheeler, Stephanie B.
AU - Caleb Alexander, G.
AU - Pate, Virginia
AU - Alan Brookhart, M.
N1 - Funding Information:
Dr Seamans was supported by the UNC Graduate School Dissertation Completion Fellowship and the National Institutes of Health (T32 CA201159). The database infrastructure used for this project was funded by the Department of Epidemiology, UNC Gillings School of Global Public Health; the Cecil G. Sheps Center for Health Services Research, UNC; the CER Strategic Initiative of UNC’s Clinical Translational Science Award (UL1TR001111); and the UNC School of Medicine.
Funding Information:
receives research support from the National Institutes of Health (NIH) (DP2 HD084070) and is a scientific advisor to Sanofi-Pasteur on unrelated projects. Dr Wheeler receives research support from Pfizer Inc on unrelated projects. Dr Alexander is Chair of the FDA’s Peripheral and Central Nervous System Advisory Committee, is a paid consultant to QuintilesIMS, serves on the Advisory Board of MesaRx Innovations, holds equity in Monument Analytics, and serves as a member of OptumRx’s P&T Committee. This arrangement has been reviewed and approved by the Johns Hopkins Bloomberg School of Public Health. Dr Brookhart receives investigator-initiated research funding from the NIH (R01 AG042845; R21 HD080214; R01 AG023178) and through contracts with the Agency for Healthcare Research and Quality's Developing Evidence to Inform Decision Effectiveness program and the Patient Centered Outcomes Research Institute. Dr Brookhart has received research support from Amgen and AstraZeneca and has served as a scientific advisor for Amgen, Merck, GlaxoSmithKline, UCB BioSciences, RxAnte, and World Health Information Consultants.
Funding Information:
the UNC Graduate School Dissertation Completion Fellowship and the National Institutes of Health (T32 CA201159). The database infrastructure used for this project was funded by the Department of Epidemiology, UNC Gillings School of Global Public Health; the Cecil G. Sheps Center for Health Services Research, UNC; the CER Strategic Initiative of UNC’s Clinical Translational Science Award (UL1TR001111); and the UNC School of Medicine.
Publisher Copyright:
© 2017 American Medical Association.
PY - 2018/1
Y1 - 2018/1
N2 - IMPORTANCE Increases in prescription opioid use in the United States have been attributed to changing prescribing guidelines and attitudes toward pain relief; however, the spread of opioid use within households through drug diversion may also be a contributing factor. OBJECTIVE To investigate whether individuals living in a household with a prescription opioid user are more likely to initiate prescription opioids themselves, compared with individuals in households with a prescription nonsteroidal anti-inflammatory drug (NSAID) user. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective cohort study using administrative health care claims data from 2000 to 2014 of commercial insurance beneficiaries sharing a health plan with continuous prescription drug coverage, without opioid or NSAID use in the prior year. Enrollees were followed from the date of the first prescription filled by a household member for an eligible opioid or NSAID until initiation of prescription opioids, disenrollment, or administrative censoring after 1 year or the end of follow-up on December 31, 2014. Risk of opioid initiation was derived from inverse probability-weighted (IPW) Kaplan-Meier estimators that adjusted for potential confounders, prognostic factors, and predictors of censoring. EXPOSURE Outpatient pharmacy dispensing of a prescription opioid or prescription NSAID. MAIN OUTCOMES AND MEASURES Incident outpatient pharmacy fill for a prescription opioid by a household member. RESULTS From 2000 to 2014, 12 695 280 individuals were exposed to prescription opioids and 6 359 639 to prescription NSAIDS through an index prescription to a household member. The IPW estimated risk of opioid initiation in the subsequent year was 11.83% (95% CI, 11.81%-11.85%) among individuals exposed to prescription opioids in the household, compared with 11.11% (95% CI, 11.09%-11.14%) among individuals exposed to prescription NSAIDs, resulting in a risk difference of 0.71% (95% CI, 0.68%-0.74%). An unmeasured confounder that is modestly associated with the exposure (eg, prevalence difference = 0.9%) and the outcome (eg, risk difference = 0.9) after adjustment for all measured variables could explain our observed estimate of the overall risk difference (0.71%). CONCLUSIONS AND RELEVANCE Living in a household with a prescription opioid user may increase risk of prescription opioid use, which may reflect both increased access to these products as well as shared risk factors, such as prescriber preference and prescription drug monitoring.
AB - IMPORTANCE Increases in prescription opioid use in the United States have been attributed to changing prescribing guidelines and attitudes toward pain relief; however, the spread of opioid use within households through drug diversion may also be a contributing factor. OBJECTIVE To investigate whether individuals living in a household with a prescription opioid user are more likely to initiate prescription opioids themselves, compared with individuals in households with a prescription nonsteroidal anti-inflammatory drug (NSAID) user. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective cohort study using administrative health care claims data from 2000 to 2014 of commercial insurance beneficiaries sharing a health plan with continuous prescription drug coverage, without opioid or NSAID use in the prior year. Enrollees were followed from the date of the first prescription filled by a household member for an eligible opioid or NSAID until initiation of prescription opioids, disenrollment, or administrative censoring after 1 year or the end of follow-up on December 31, 2014. Risk of opioid initiation was derived from inverse probability-weighted (IPW) Kaplan-Meier estimators that adjusted for potential confounders, prognostic factors, and predictors of censoring. EXPOSURE Outpatient pharmacy dispensing of a prescription opioid or prescription NSAID. MAIN OUTCOMES AND MEASURES Incident outpatient pharmacy fill for a prescription opioid by a household member. RESULTS From 2000 to 2014, 12 695 280 individuals were exposed to prescription opioids and 6 359 639 to prescription NSAIDS through an index prescription to a household member. The IPW estimated risk of opioid initiation in the subsequent year was 11.83% (95% CI, 11.81%-11.85%) among individuals exposed to prescription opioids in the household, compared with 11.11% (95% CI, 11.09%-11.14%) among individuals exposed to prescription NSAIDs, resulting in a risk difference of 0.71% (95% CI, 0.68%-0.74%). An unmeasured confounder that is modestly associated with the exposure (eg, prevalence difference = 0.9%) and the outcome (eg, risk difference = 0.9) after adjustment for all measured variables could explain our observed estimate of the overall risk difference (0.71%). CONCLUSIONS AND RELEVANCE Living in a household with a prescription opioid user may increase risk of prescription opioid use, which may reflect both increased access to these products as well as shared risk factors, such as prescriber preference and prescription drug monitoring.
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U2 - 10.1001/jamainternmed.2017.7280
DO - 10.1001/jamainternmed.2017.7280
M3 - Article
C2 - 29228098
AN - SCOPUS:85039995188
VL - 178
SP - 102
EP - 109
JO - Archives of internal medicine (Chicago, Ill. : 1908)
JF - Archives of internal medicine (Chicago, Ill. : 1908)
SN - 2168-6106
IS - 1
ER -