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Cited by 90Opioid Use Disorder TreatmentPharmaceutical Practices and Patient OutcomesPain Management and Opioid Use

Association of Opioid Prescribing Patterns With Prescription Opioid Overdose in Adolescents and Young Adults

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Chua, Kao-Ping, Brummett, Chad M., Conti, Rena M., Bohnert, Amy·2020·JAMA Pediatrics
DOI 10.1001/jamapediatrics.2019.4878PMC PMC6990690
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Abstract

Importance: Safe opioid prescribing practices are critical to mitigate the risk of prescription opioid overdose in adolescents and young adults. However, studies that examine opioid prescribing patterns associated with prescription opioid overdose have mostly focused on older adults. The generalizability of these studies to adolescents and young adults is unclear. Objective: To identify opioid prescribing patterns associated with prescription opioid overdose in adolescents and young adults. Design, Setting, and Participants: This retrospective cohort study assessed privately insured patients aged 12 to 21 years with opioid prescription claims in the IBM MarketScan Commercial Claims and Encounters database between July 1, 2009, and October 1, 2017, and no cancer diagnosis. Data analysis was performed from January 1 to April 30, 2019. Main Outcomes and Measures: The outcome was a treated opioid overdose as indicated by diagnosis codes. On the basis of days supplied, opioid prescription claims were converted to person-days (the unit of analysis) on which opioid exposure would occur if patients took medications as prescribed. Logistic regression with clustered SEs at the patient level was used to model the occurrence of overdose on a person-day as a function of daily opioid dosage category (<30, 30-59, 60-89, 90-119, or ≥120 morphine milligram equivalents), concurrent benzodiazepine use, and extended-release or long-acting opioid use. Regressions controlled for demographic characteristics, year, opioid use within 180 days, and comorbidities (mental health disorder, substance use disorder, and other chronic condition). Results: A total of 2 752 612 patients (mean [SD] age at cohort entry, 17.2 [2.5] years; 1 451 918 [52.8%] female) participated in the study. Patients had 4 686 355 opioid prescription claims, corresponding to 21 605 444 person-days. Overdose occurred on 255 person-days among 249 patients (0.01% of the sample). Each increase in daily opioid dosage category was associated with higher overdose risk (adjusted odds ratio [AOR], 1.18; 95% CI, 1.05-1.31). Compared with no use, both concurrent benzodiazepine use (AOR, 1.83; 95% CI, 1.24-2.71) and extended-release or long-acting opioid use (AOR, 2.01; 95% CI, 1.16-3.46) were associated with increased overdose risk. Conclusions and Relevance: The findings suggest that when prescribing opioids to adolescents and young adults, practitioners could potentially mitigate overdose risk by using the lowest effective daily dosage, avoiding concurrent opioid and benzodiazepine prescribing, and relying on short-acting opioids. Findings are broadly consistent with prior opioid safety studies focused on older adults.

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  • Over reliance on prescription opioids as a frontline treatment for chronic pain contributed to a national epidemic including increased rates of opioid addiction, accidental overdose, and mortality.

    “Over reliance on the use of prescription opioids as a frontline treatment for chronic pain contributed to a national epidemic including increased rates of opioid addiction, accidental overdose, and even mortality [16–20].”

    From Benchmark findings from a veteran electronic patient-reported outcomes evaluation from a chronic pain management telehealth program (2024) · cites this paper as [18]

    The introductory passage labeled Abstract (page not provided) links opioid prescribing in adolescents and young adults to misuse and overdose, and reports prescription opioids in nearly 30% of their opioid-related overdose deaths in 2016. It does not establish that reliance on opioids as frontline treatment for chronic pain caused a national epidemic or increased addiction and mortality rates; the study examines overdose associations in privately insured patients aged 12–21. (LLM, conf=0.86)

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Authors
Chua, K.-P., Brummett, C. M., Conti, R. M., & Bohnert, A.
Affiliations
  • University of Michigan (US)
  • Boston University (US)
Corresponding author
Chua, Kao-Ping
ORCID
Venue
JAMA Pediatrics
Publisher
American Medical Association (AMA)
Published
2020-02-01
Volume
174
Issue
2
Pages
141
ISSN
  • 1072-4710 (ISSN-L)
  • 2168-6203
DOI
10.1001/jamapediatrics.2019.4878
PMC
PMC6990690
OpenAlex
W2996612114
Cited by
90
References
38
Citations by year
2026: 5 · 2025: 8 · 2024: 15 · 2023: 9 · 2022: 20 · 2021: 28 · 2020: 4 · 2019: 1
FWCI
12.20
Type
journal article
Language
en
Open access
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute on Drug Abuse (K08DA048110)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
prescription opioid overdose, opioid prescribing patterns, adolescents, young adults, benzodiazepine use, extended-release opioids, long-acting opioids, opioid exposure, opioid overdose risk, opioid analgesics
MeSH terms
Adolescent, Analgesics, Opioid, Child, Female, Humans, Male, Practice Patterns, Physicians', Drug Prescriptions, Retrospective Studies, Cohort Studies, Young Adult, Drug Overdose

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