Association of opioid prescription initiation during adolescence and young adulthood with subsequent substance-related morbidity
Open accessAbstract
Importance: Concerns about adverse outcomes associated with opioid analgesic prescription have led to major guideline and policy changes. Substantial uncertainty remains, however, regarding the association between opioid prescription initiation and increased risk of subsequent substance-related morbidity. Objective: To examine the association of opioid initiation among adolescents and young adults with subsequent broadly defined substance-related morbidity. Design, Setting, and Participants: This cohort study analyzed population-register data from January 1, 2007, to December 31, 2013, on Swedish individuals aged 13 to 29 years by January 1, 2013, who were naive to opioid prescription. To account for confounding, the analysis compared opioid prescription recipients with recipients of nonsteroidal anti-inflammatory drugs as an active comparator, compared opioid-recipient twins and other multiple birth individuals with their nonrecipient co-multiple birth offspring (co-twin control), examined dental prescription as a specific indication, and included individual, parental, and socioeconomic covariates. Data were analyzed from March 30, 2019, to January 22, 2020. Exposures: Opioid prescription initiation, defined as first dispensed opioid analgesic prescription. Main Outcomes and Measures: Substance-related morbidity, assessed as clinically diagnosed substance use disorder or overdose identified from inpatient or outpatient specialist records, substance use disorder or overdose cause of death, dispensed pharmacotherapy for alcohol use disorder, or conviction for substance-related crime. Results: Among the included cohort (n = 1 541 862; 793 933 male [51.5%]), 193 922 individuals initiated opioid therapy by December 31, 2013 (median age at initiation, 20.9 years [interquartile range, 18.2-23.6 years]). The active comparator design included 77 143 opioid recipients without preexisting substance-related morbidity and 229 461 nonsteroidal anti-inflammatory drug recipients. The adjusted cumulative incidence of substance-related morbidity within 5 years was 6.2% (95% CI, 5.9%-6.5%) for opioid recipients and 4.9% (95% CI, 4.8%-5.1%) for nonsteroidal anti-inflammatory drug recipients (hazard ratio, 1.29; 95% CI, 1.23-1.35). The co-twin control design produced comparable results (3013 opioid recipients and 3107 nonrecipients; adjusted hazard ratio, 1.43; 95% CI, 1.02-2.01), as did restriction to analgesics prescribed for dental indications and additional sensitivity analyses. Conclusions and Relevance: Among adolescents and young adults analyzed in this study, initial opioid prescription receipt was associated with an approximately 30% to 40% relative increase in risk of subsequent substance-related morbidity in multiple designs that adjusted for confounding. These findings suggest that this increase may be smaller than previously estimated in some other studies.
AI snapshot
Written from the paper’s full text.
TL;DR
In a nationwide Swedish cohort of adolescents and young adults, opioid prescription initiation was associated with a modestly higher risk of subsequent substance-related morbidity after confounding adjustment. The adjusted relative increase was approximately 30% to 40%, smaller than some prior estimates.
Key findings
- Among 1,541,862 opioid-naive individuals aged 13 to 29 years, 193,922 (12.6%) initiated opioid therapy by December 31, 2013; median age at initiation was 20.9 years (IQR, 18.2-23.6).
- In the active comparator design (77,143 opioid recipients vs 229,461 NSAID recipients without preexisting substance-related morbidity), adjusted 5-year cumulative incidence was 6.2% (95% CI, 5.9%-6.5%) for opioid recipients vs 4.9% (95% CI, 4.8%-5.1%) for NSAID recipients; adjusted HR, 1.29 (95% CI, 1.23-1.35).
- In the co-twin control design (3013 opioid recipients vs 3107 nonrecipients), adjusted HR was 1.43 (95% CI, 1.02-2.01).
- Dental opioid initiation was associated with substance-related morbidity in the demographically matched comparison (HR, 1.84; 95% CI, 1.55-2.17) and, attenuated, in the active comparator design (HR, 1.33; 95% CI, 1.11-1.59).
Methods
- Population-register cohort study using linked Swedish national registers from January 1, 2007, to December 31, 2013, including individuals aged 13 to 29 years by January 1, 2013, who were opioid-prescription naive.
- Three main designs compared opioid recipients with nonrecipients: a demographically matched comparison, an active comparator design comparing opioid initiators with NSAID initiators using inverse probability of treatment weighting, and a co-twin control design comparing twins or other multiple birth individuals within families.
- Substance-related morbidity was defined as clinically diagnosed substance use disorder or overdose, substance use disorder or overdose cause of death, dispensed pharmacotherapy for alcohol use disorder, or conviction for substance-related crime; Cox proportional hazards regression estimated hazard ratios and 5-year cumulative incidence.
Limitations
- The paper states that the active comparator design cannot account for unmeasured factors differentiating opioid and NSAID initiators and assumes no increased risk of substance-related morbidity due to NSAID initiation; the co-twin control design is susceptible to lower precision and bias from unmeasured within-family confounding and measurement error.
- The paper states that it could not entirely rule out confounding from characteristics of analgesia indications, that the outcome measure likely captured only more severe outcomes, that initiation was assessed from dispensed prescriptions rather than prescriptions written or taken, and that generalizability outside Sweden and after 2013 is unknown.
- Evident from the text: this is an observational study, so residual confounding cannot be excluded; the co-twin control estimate had a wide confidence interval and some sensitivity analyses were not statistically significant.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 19 cited sources checked · 0 supported · 0 flagged
- Findingown data
Multiple birth individuals initiating treatment with immediate-release weak opioids had a similarly greater hazard of substance-related morbidity (HR, 1.40; 95% CI, 0.96-2.02), although the estimate was not statistically significant.
“Multiple birth individuals initiating treatment with immediaterelease weak opioids had similarly greater hazard of substancerelated morbidity (HR, 1.40, 95% CI, 0.96-2.02),although the estimate was not statistically significant.”
Quote in the paperNot a substantial claim - Findingown data
The active comparator association was virtually unchanged across technical specifications.
“Fifth, the active comparator association was virtually unchanged across technical specifications”
Quote in the paperNot a substantial claim - Findingown data
In the adjusted active comparator design among dental initiators, hazard of incident substance-related morbidity was 33% relatively greater among opioid recipients than among NSAID recipients (HR, 1.33; 95% CI, 1.11-1.59).
“Among 17 438 dental initiators (52.1% female; 37.1% opioid recipients), hazard of incident substance-related morbidity was 33% relatively greater among opioid recipients than among NSAID recipients (HR, 1.33; 95% CI, 1.11-1.59).”
Quote in the paperSubstantial claim - Findingown data
In the co-twin control design, opioid recipients had 43% relatively greater hazard of substance-related morbidity than their nonrecipient co-twins or other multiple birth individuals (HR, 1.43; 95% CI, 1.02-2.01).
“The co-twin control design produced comparable results (3013 opioid recipients and 3107 nonrecipients; adjusted hazard ratio, 1.43; 95% CI, 1.02-2.01)”
- Also stated in: § Co-Twin Control Design · plain
“opioid recipients had 43% relatively greater hazard of substance-related morbidity than did their nonrecipient cotwins or other multiple birth individuals (HR, 1.43; 95% CI, 1.02-2.01)”
Quote in the paperSubstantial claim - Also stated in: § Co-Twin Control Design · plain
- Findingown data
In the active comparator design, opioid recipients had a 29% relatively greater hazard of substance-related morbidity than NSAID recipients (HR, 1.29; 95% CI, 1.23-1.35).
“(hazard ratio, 1.29; 95% CI, 1.23-1.35)”
- Also stated in: § Active Comparator Design · plain
“opioid recipients had a 29% relatively greater hazard of substance-related morbidity than did NSAID recipients (HR, 1.29; 95% CI, 1.23-1.35)”
Quote in the paperSubstantial claim - Also stated in: § Active Comparator Design · plain
- Findingown data
Excluding those dispensed buprenorphine or methadone did not alter the active comparator association.
“excluding those dispensed buprenorphine or methadone did not alter the active comparator associa- tion”
Quote in the paperNot a substantial claim - Findingown data
In the active comparator design among individuals without preexisting substance-related morbidity, the 5-year cumulative incidence of new substance-related morbidity was 6.2% (95% CI, 5.9%-6.5%) for opioid recipients and 4.9% (95% CI, 4.8%-5.1%) for NSAID recipients.
“The adjusted cumulative incidence of substance-related morbidity within 5 years was 6.2% (95% CI, 5.9%-6.5%)for opioid recipients and 4.9% (95% CI, 4.8%-5.1%)for nonsteroidal anti-inflammatory drug recipients”
- Also stated in: § Active Comparator Design · plain
“the inverse probability of treatment-weighted cumulative incidence of new substance-related morbidity was 6.2% (95% CI, 5.9%-6.5%)for opioid recipients and 4.9% (95% CI, 4.8%-5.1%)for NSAID recipients”
Quote in the paperSubstantial claim - Also stated in: § Active Comparator Design · plain
- Findingown data
In the demographically matched comparison, opioid recipients had approximately twice the hazard/rate of incident substance-related morbidity compared with nonrecipients (HR, 1.98; 95% CI, 1.91-2.07).
“That is, opioid recipients had twice the hazard of incident substance-related morbidity (HR, 1.98; 95% CI, 1.91-2.07)”
- Also stated in: § Discussion · plain
“opioid-prescription initiators had approximately doubled rates of incident substance-related morbidity relative to noninitiators”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Findingown data
Individuals initiating treatment with immediate-release weak opioids had a similarly greater hazard of substance-related morbidity relative to NSAID recipients (HR, 1.31; 95% CI, 1.25-1.37).
“Individuals initiating treatment with immediate-release weak opioids had a similarly greater hazard of substance-related morbidity relative to NSAID recipients (HR, 1.31; 95% CI, 1.25-1.37).”
Quote in the paperSubstantial claim - Findingown data
The unadjusted active comparator association among all eligible individuals (HR, 1.41; 95% CI, 1.35-1.47) was similar to that for the complete case cohort (HR, 1.40; 95% CI, 1.34-1.47).
“Sixth, the unadjusted active com- parator association among all eligible individuals (HR, 1.41; 95% CI, 1.35-1.47) was similar to that for the complete case cohort (HR, 1.40; 95% CI, 1.34-1.47)”
Quote in the paperNot a substantial claim - Findingown data
In the demographically matched comparison among individuals without preexisting substance-related morbidity, the 5-year cumulative incidence of new substance-related morbidity was 7.1% (95% CI, 6.9%-7.2%) for opioid recipients and 3.7% (95% CI, 3.6%-3.9%) for matched nonrecipients.
“Among those without preexisting substance-related morbidity, the cumulative incidence of new substance-related morbidity within 5 years was 7.1% (95% CI, 6.9%-7.2%)for opioid recipients and 3.7% (95% CI, 3.6%-3.9%)for demographically matched nonrecipients”
Quote in the paperSubstantial claim - Findingown data
Median age at opioid initiation was 20.9 years (IQR, 18.2-23.6 years).
“median age at initiation, 20.9 years [interquartile range, 18.2-23.6years]”
- Also stated in: § Results · plain
“median age at initiation, 20.9 years [IQR, 18.2-23.6years]”
Quote in the paperNot a substantial claim - Also stated in: § Results · plain
- Findingown data
Relative to demographically matched nonrecipients, dental opioid recipients had a nearly doubled hazard of incident substance-related morbidity (HR, 1.84; 95% CI, 1.55-2.17).
“Relative to demographically matched nonrecipients, the 11 096 dental opioid recipients (57.5% female) had a nearly doubled hazard of incident substance-related morbidity (HR, 1.84; 95% CI, 1.55-2.17).”
Quote in the paperSubstantial claim - Findingown data
Associations persisted after excluding overdose outcomes.
“Second, associations persisted after excluding overdose outcomes, suggesting that they were not entirely driven by overdoses”
Quote in the paperSubstantial claim - Findingown data
In the co-twin control design, for immediate-release weak opioids only, the hazard ratio for subsequent substance-related morbidity associated with opioid initiation was 1.40 (95% CI, 0.96-2.02).
“Plus immediate-release weak opioids only | NA | 1.31 (1.25-1.37) | 1.40 (0.96-2.02)”
Quote in the paperNot a substantial claim - Findingown data
In the demographically matched design, after excluding preexisting substance-related morbidity, opioid initiation was associated with subsequent substance-related morbidity (HR, 1.98; 95% CI, 1.91-2.07).
“Plus no preexisting substance-related morbidity | 1.98 (1.91-2.07) | 1.40 (1.34-1.47) | 1.44 (1.05-1.97)”
Quote in the paperSubstantial claim - Findingown data
In the co-twin control design, after adjustment, opioid initiation was associated with subsequent substance-related morbidity (HR, 1.43; 95% CI, 1.02-2.01).
“Plus adjusted | NA | 1.29 (1.23-1.35) | 1.43 (1.02-2.01)”
Quote in the paperSubstantial claim - Findingown data
We found associations even for weaker opioids.
“we found associations even for weaker opioids”
Quote in the paperNot a substantial claim - Findingown data
In the NSAID active comparator design, after adjustment, opioid initiation was associated with subsequent substance-related morbidity (HR, 1.29; 95% CI, 1.23-1.35).
“Plus adjusted | NA | 1.29 (1.23-1.35) | 1.43 (1.02-2.01)”
Quote in the paperSubstantial claim- The authors state this as an assumption: The active comparator design assumes no increased risk of substance-related morbidity due to NSAID initiation.
- Findingown data
In the NSAID active comparator design, for immediate-release weak opioids only, opioid initiation was associated with subsequent substance-related morbidity (HR, 1.31; 95% CI, 1.25-1.37).
“Plus immediate-release weak opioids only | NA | 1.31 (1.25-1.37) | 1.40 (0.96-2.02)”
Quote in the paperSubstantial claim- The authors state this as an assumption: The active comparator design assumes no increased risk of substance-related morbidity due to NSAID initiation.
- Interpretationown data
The complete covariate case approach did not meaningfully bias the results.
“suggesting that the complete co- variate case approach did not meaningfully bias the results”
Quote in the paperNot a substantial claim - Study design and conductreasoning
The present study used multiple designs to address measured and unmeasured confounders, including analgesia indications, individual and familial risk for substance-related morbidity, and other genetic and environmental factors.
“Third, this study used multiple designs to address measured and unmeasured confounders, including analgesia indications, individual and familial risk for substance-related morbidity, and other genetic and environmental factors.”
Quote in the paperSubstantial claim - Interpretationown data
Among adolescents and young adults analyzed in this study, initial opioid prescription receipt was associated with an approximately 30% to 40% relative increase in risk of subsequent substance-related morbidity in multiple designs that adjusted for confounding.
“Among adolescents and young adults analyzed in this study, initial opioid prescription receipt was associated with an approximately 30% to 40% relative increase in risk of subsequent substance-related morbidity in multiple designs that adjusted for confounding.”
- Also stated in: § Discussion · plain
“opioid initiation was associated with an approximately 30% to 40% relative increase in rates of substance-related morbidity”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Study design and conductreasoning
The active comparator design adjusted for confounding from all factors shared across individuals initiating analgesic treatment with opioids and with NSAIDs.
“This approach adjusted for confounding from all factors shared across individuals initiating analgesic treatment with opioids and with NSAIDs (eg, indications for pain treatment)”
Quote in the paperSubstantial claim0 of 3 sources checked - Interpretationown data
Use of active comparator and co-twin control designs to reduce confounding weakened but did not entirely attenuate the association between opioid initiation and substance-related morbidity.
“Use of active comparator and co-twin control designs to reduce confounding weakened but did not entirely attenuate this association: opioid initiation was associated with an approximately 30% to 40% relative increase in rates of substance-related morbidity.”
Quote in the paperSubstantial claim - Interpretationown data
After adjustment, the increase in substance-related morbidity was smaller in relative and absolute terms than has been found in some previous studies.
“Even so, after adjustment, the increase was smaller in relative and absolute terms than has been found in some previous studies.”
Quote in the paperNot a substantial claim - Study design and conductreasoning
The cohort had 1.5 years or more of prescription opioid-free washout because prescription data were available from July 2005 onward.
“Because prescription data were available from July 2005 onward, the cohort had 1.5 years or more of prescription opioid-free washout.”
Quote in the paperSubstantial claim - Interpretationown data
This increase may be smaller than previously estimated in some other studies.
“These findings suggest that this increase may be smaller than previously estimated in some other studies.”
Quote in the paperNot a substantial claim - Interpretationown data
Misclassified substance use disorder treatment did not bias the results.
“suggesting that misclassified substance use dis- order treatment did not bias the results”
Quote in the paperSubstantial claim - Interpretationown data
The associations were not entirely driven by overdoses.
“suggesting that they were not entirely driven by overdoses”
Quote in the paperSubstantial claim - Interpretationown data
Increased risk of substance-related morbidity persisted in multiple designs, including among individuals initiating therapy with weaker opioids.
“In the present study, increased risk of substancerelated morbidity persisted in multiple designs, including among individuals initiating therapy with weaker opioids.”
Quote in the paperSubstantial claim - Study design and conductcitation
The co-twin control design rules out processes shared across twin pairs that may nevertheless contribute to substance-related morbidity, such as household opioid availability following prescription to either twin.
“This design additionally rules out processes shared across twin pairs that may nevertheless contribute to substance-related morbidity”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [65]
Not checked in the free run.
- cites [66] source
Not checked in the free run.
- Study design and conductnone given
Our measurement of substance-related morbidity likely captured only more severe outcomes (eg, convictions, deaths, and specialist treatment).
“this measure likely captured only more severe outcomes (eg, convictions, deaths, and specialist treatment)”
Quote in the paperNot a substantial claim - Premisecitation
Initiation can lead to long-term opioid therapy for some individuals.
“initiation can lead to long-term opioid therapy for some individuals”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [70]
Not checked in the free run.
- Interpretationown data
The comparable results across multiple designs may support the conclusions from this study.
“the comparable results across multiple designs may support the conclusions from this study”
Quote in the paperSubstantial claim - Study design and conductcitation
We could not entirely rule out confounding from characteristics of analgesia indications (eg, injury severity, pain-related impairment and distress) that may differentiate opioid recipients from NSAID recipients and co-twins and other multiple birth individuals.
“we could not entirely rule out confounding from characteristics of analgesia indications (eg, injury severity, pain-related impairment and distress) that may differentiate opioid recipients from NSAID recipients and co-twins and other multiple birth individuals.”
Quote in the paperNot a substantial claim0 of 2 sources checked - Interpretationown data
The increase in risk of substance-related morbidity due to opioid initiation may be smaller than has been estimated in some previous studies.
“suggest that this increase may be smaller than has been estimated in some previous studies”
Quote in the paperSubstantial claim - Premisecitation
Risk may vary as a function of treatment duration.
“risk may vary as a function of treatment duration”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [29] source
Not checked in the free run.
- Premisecitation
Patterns of opioid prescription among those with substance use disorder appear similar in Sweden and the US.
“patterns of opioid prescription among those with substance use disorder appear similar in Sweden and the US”
Quote in the paperNot a substantial claim0 of 2 sources checked - Study design and conductcitation
The co-twin control design is susceptible to lower precision and bias from unmeasured within-family confounding and measurement error.
“The co-twin control design is susceptible to lower precision and bias from unmeasured within-family confounding and measurement error.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [64] source
Not checked in the free run.
- Study design and conductcitation
The active comparator design cannot account for unmeasured factors that differentiate opioid and NSAID initiators.
“The active comparator design cannot account for unmeasured factors that differentiate opioid and NSAID initiators”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [42] source
Not checked in the free run.
- Interpretationown data
The results of this study do not rule out a nontrivial increase in risk of substance-related morbidity due to opioid initiation.
“The results of this study do not rule out a nontrivial increase in risk of substance-related morbidity due to opioid initiation”
Quote in the paperSubstantial claim
- May combine two claims. 6
- The quote only partly states this claim. 2
- Classified as probably not a substantial claim. 14
May combine two claims.
Findingown dataThe adjusted co-twin control association persisted but was not statistically significant when excluding nontwin multiple birth individuals.
“Seventh, the adjusted co-twin control association persisted but was not statistically significant when excluding nontwin mul- tiple birth individuals”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataIn sensitivity analyses, excluding criminal outcomes did not inflate the association; the demographically matched comparison was similar for noncriminal substance-related morbidity (HR, 2.08; 95% CI, 1.98-2.18).
“First, the inclusion of criminal outcomes did not inflate the association; the demographically matched comparison was similar for noncriminal substance-related morbidity (HR, 2.08; 95% CI, 1.98-2.18).”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataAmong the included Swedish cohort of 1,541,862 individuals aged 13 to 29 years by January 1, 2013, who were opioid-prescription naive, 193,922 individuals (12.6%) initiated opioid therapy by December 31, 2013.
“Among the included cohort (n = 1 541 862; 793 933 male [51.5%]), 193 922 individuals initiated opioid therapy by December 31, 2013”
- Also stated in: § Results · plain
“Among the cohort, 193 922 individuals (12.6%) initiated opioid therapy by December 31, 2013”
Quote in the paperNot a substantial claim- Also stated in: § Results · plain
The quote only partly states this claim.
Findingown dataIn the co-twin control design among twins or other multiple birth individuals without preexisting substance-related morbidity, the 5-year cumulative incidence of new substance-related morbidity was 5.9% (95% CI, 4.6%-7.1%) for opioid recipients and 4.2% (95% CI, 3.2%-5.2%) for nonrecipients.
“Among twins or other multiple birth individuals without preexisting substance-related morbidity, the cumulative incidence of new substance-related morbidity was 5.9% (95% CI, 4.6%-7.1%)for opioid recipients and 4.2% (95% CI, 3.2%-5.2%)for nonrecipients.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe associations remained moderate in magnitude among adolescents and young adults separately, albeit with statistically nonsignificant co-twin control associations.
“Fourth, the associations remained moderate in magnitude among adolescents and young adults separately, albeit with statistically nonsignificant co-twin control asso- ciations (unadjusted because of limited sample size)”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe most common strong opioid was oxycodone (8.3%).
“The most common strong (ie, not weak) opioid was oxycodone (8.3%).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingnone givenThe cohort represented 93.2% of the original births and 97.1% of those alive who had not emigrated by the start of follow-up.
“This cohort represented 93.2% of the original births and 97.1% of those alive who had not emigrated by the start of follow-up.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataTreatment in most individuals was initiated with codeine (56.3%) or tramadol (25.6%).
“Treatment in most individuals was initiated with codeine (56.3%) or tramadol (25.6%)”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe study assessed a range of potential confounders preceding opioid initiation, including individual, maternal pregnancy-related, parental, and socioeconomic factors.
“We assessed a range of potential confounders, focusing on factors preceding opioid initiation that were possible contribu-tors to the risk of substance-related morbidity”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductown dataThe analysis used inverse probability of treatment weighting to balance measured covariates.
“we used inverse probability of treatment weighting to balance measured covariates”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataThe results were maintained for individuals receiving opioids for dental indications and for those initiating therapy with immediate-release weak opioids.
“The results were maintained for individuals receiving opioids for dental indications and for those initiating therapy with immediate-release weak opioids.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
InterpretationreasoningLater treatment patterns may serve as potential contributors to any increase in risk associated with initiation.
“later treatment patterns may serve as potential contributors to any increase in risk associated with initiation”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationOpioid overdose-related mortality has also increased substantially in Sweden.
“opioid overdose-related mortality has also increased substantially in Sweden”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningOur results are therefore analogous to an intent-to-treat approach among recipients.
“Our results are therefore analogous to an intent-to-treat approach among recipients.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [69]
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductnone givenWe assessed initiation from dispensed prescriptions rather than those written by prescribers or taken by patients.
“we assessed initiation from dispensed prescriptions rather than those written by prescribers or taken by patients”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPolysubstance use is ubiquitous and there are shared genetic and neurobiological processes underlying opioid use disorder and other substance use disorders.
“given the ubiquity of polysubstance use and the shared genetic and neurobiological processes underlying opioid use disorder and other substance use disorders”
Quote in the paperNot a substantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
Interpretationnone givenDifferences in health care systems and broader factors may influence pathways to substance-related morbidity.
“differences in health care systems and broader factors may influence pathways to substance-related morbidity”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
PremisecitationInitiation is only one aspect of the course of opioid therapy.
“Initiation is only one aspect of the course of opi-oid therapy”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [29] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningThe generalizability of our results outside Sweden and after 2013 is unknown.
“the generalizability of our results outside Sweden and after 2013 is unknown”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
InterpretationreasoningRisks may differ for specific outcomes, such as opioid overdoses.
“Risks may differ for specific outcomes, such as opioid overdoses.”
Quote in the paperNot a substantial claim
The authors state this as an assumption.
The active comparator design assumes no increased risk of substance-related morbidity due to NSAID initiation.
“assumes no increased risk of substance-related morbidity due to NSAID initiation”
The paper relies on this without support.
Pharmacologic mechanisms do not vary across countries or time.
“pharmacologic mechanisms would not vary across countries or time”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Adolescents are at an especially increased risk of developing an opioid use disorder, even after a single exposure.
“Adolescents are at an especially increased risk of developing an opioid use disorder, even after a single exposure.”
From Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults (2024) · cites this paper as [15]
The Abstract (page not provided) reports that initial opioid prescription receipt among adolescents and young adults was associated with increased subsequent substance-related morbidity. It does not establish that adolescents are at especially increased risk, isolate opioid use disorder as the outcome, or show that the risk follows just one exposure; the Opioid Prescription section defines initiation as the first dispensed prescription. (LLM, conf=0.88)
Experimental — accuracy not yet measured
The citation lists haven’t been fetched yet
References 69 · Cited by 38
- Authors
- Quinn, P. D., Fine, K. L., Rickert, M. E., Sujan, A. C., Boersma, K., Chang, Z., Franck, J., Lichtenstein, P., Larsson, H., & D’Onofrio, B. M.
- Affiliations
- Indiana University Bloomington (US)
- Örebro University (SE)
- Karolinska Institutet (SE)
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
- Corresponding author
- Quinn, Patrick D.
- ORCID
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2020-11-01
- Volume
- 174
- Issue
- 11
- Pages
- 1048
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC7418042
- OpenAlex
- W3048190301
- Semantic Scholar
- 3279ca6bc6224da4a1bfbdb2efcb3ab72f914072
- Cited by
- 38
- References
- 69
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 9 · 2023: 6 · 2022: 4 · 2021: 11
- FWCI
- 3.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Science Foundation (1342962)
- Vetenskapsrådet
- National Institute on Drug Abuse (R00DA040727)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- opioid initiation, adolescents, young adults, substance use disorders, opioid overdose, nonsteroidal anti-inflammatory drugs, prescription opioids, co-twin control, dental prescriptions, socioeconomic factors, parental factors
- MeSH terms
- Adolescent, Adolescent Behavior, Analgesics, Opioid, Female, Humans, Male, Drug Prescriptions, Retrospective Studies, Sweden, Cohort Studies, Comorbidity, Substance-Related Disorders, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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