Prescription Opioid Users Raise Risk of Use for Others in Household

Marissa Seamans, PhD

Those who live in a household with a prescription opioid user may be at a higher risk of prescription opioid use themselves, according to new data published in JAMA Internal Medicine.

The study was led by Marissa J. Seamans, PhD, a postdoctoral fellow in the Department of Mental Health at Johns Hopkins School of Public Health, in Baltimore, Maryland. The investigators retroactively analyzed data from administrative health care claims data to compare the risk faced by those in households with opioid prescription users to those in households with prescription non-steroidal anti-inflammatory drug (NSAID) users.

The study included 12.7 million individuals exposed to opioids and 6.4 million individuals exposed to NSAIDs from 2000 to 2014.

“Although we found a small absolute increase in the risk of subsequent opioid use by others, this matters for public health if you add up the millions of opioids that are prescribed in the US,” Seamans told MD Magazine. “Management of acute and chronic pain is not just an issue for an individual patient, but also for families and society.”

Data showed that those in a household with a prescription opioid user had an inverse probability-weighted (IPW) Kaplan-Meier estimated risk of initiating opioid use in the subsequent year of 11.83% (95% CI, 11.81%-11.85%), compared to 11.11% in those exposed to prescription NSAIDs.

The risk difference of 0.71% (95% CI, 0.68%-0.74%) reflects, according to the investigators, an increased level of access to opioids, as well as the shared risk factors such as the preference of prescriber and the presence of prescription drug monitoring.

Opioids, a topic of contention in recent months, have already been found to often be misused and stored improperly by a majority of patients. Additionally, opioids have most negatively impacted baby boomers and millennials in terms of addiction.

“Patients need to be counseled on safe storage of opioids and how unused opioids should be disposed, but sometimes physicians prescribe too much and lack knowledge of proper disposal methods,” Seamans said. Safe disposal sites also may be lacking, so there is much room for improvement.”

According to Seamans, there must be some consideration by physicians about the context these medications will be used in. She noted that acknowledging whether or not more than 1 opioid user lives in the household is important addressing the concern about cross use and unsafe storage.

“A question such as ‘Some patients take pain medications from other family members, does that ever happen in your home?’ might be an important step towards assessing the potential for sharing opioids and risks to other individuals,” she said.

The data also raises the question of whether or not the use of non-opioid pain relievers is the answer to the epidemic. While data from this study showed those exposed to NSAIDs are less likely to become opioid users, studies have shown that in emergency situations, non-opioid pain relievers are equivalent, if not better, than their opioid counterparts.

“There is increasing evidence that non-opioid pain relievers work just as well as (or better than) opioids for treating non-cancer pain, yet there are many more reasons to be cautious of opioid use,” Seamans said. ”Opioids are one of the riskiest classes of medications providers prescribe, much like chemotherapy, antipsychotics, and anticoagulants.”

Recently, a study from Brigham and Women’s Hospital and Harvard University showed that refills for opioids could be minimized or eliminated post-procedure by finding the optimal prescription lengths for different procedures. “Prescribing the smallest amount of opioids required and without unnecessary refills should be considered,” Seamans added.