27 Feb When Evaluating Teens for Surgery, Check Family Opioid Use
MedicalResearch.com Interview with:
Calista Harbaugh, MD
House Officer, General Surgery
Clinician Scholar, National Clinician Scholars Program
Michigan Opioid Prescribing Engagement Network
University of Michigan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Nonmedical prescription opioid use and prescription opioid-related overdose remain significant concerns among adolescents and young adults. Among adolescents and young adults prescribed an opioid after surgery, prior work found that 4.8% of opioid-naïve patients develop new persistent use, filling additional opioid prescriptions at 3-6 months after surgery. This work found associations of persistent use with diagnoses such as chronic pain disorders, depression, anxiety, and prior substance use disorder. It is likely that for young patients, family members may also play an important role in development of new persistent use, but this has not previously been explored. We performed this study to evaluate whether long-term opioid use among family members was associated with prescription opioid fills among adolescents and young adults perioperatively – and we found that opioid-naïve adolescents and young adults who have 1 or more family members with long-term opioid use are more likely to fill at the time of surgery, during recovery, and in the long-term with a near-doubling of rates of new persistent use.
MedicalResearch.com: What should readers take away from your report?
Response: Long-term opioid use among family members is associated with increased opioid fills at all times points in the perioperative period among teens undergoing surgery – in particular, the rate of new persistent use nearly doubles among teens who have family members with long-term use. It is important to note that this study uses insurance claims, so we can only look at opioid prescription fills, but not who used them (for example, they could be diverted to family member) or how they were used (use or misuse). In any of these scenarios, however, we would be concerned that the opioids we are prescribing may increase risk of opioid-related morbidity or mortality among teen patients or their family members and must be both identified and addressed.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: When evaluating teens for a surgery where an opioid will be needed to manage post-procedural pain, it is important to assess for risk of new persistent use so that clinicians can enhance monitoring and lower thresholds for intervention if needed. Future research is needed to create 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. 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.
Disclosures: This work was funded in part by the Substance Abuse and Mental Health Services Administration (E20180568-001) and the Centers for Medicare & Medicaid Services (E20180672-00)
Harbaugh CM, Lee JS, Chua K, et al. Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults. JAMA Surg. Published online February 27, 2019. doi:10.1001/jamasurg.2018.5838
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