Patterns of Prescription Opioid Use in US Households

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  • March 20, 2019
Creator
  • Seamans, Marissa
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Opioid prescriptions in the United States have increased 300% over the past two decades, totaling 238 million dispensed in 2011. Increased prescribing has been attributed to multiple factors including changes in pain treatment guidelines and pharmaceutical marketing, but given high rates of prescription drug sharing between family members, the household context of opioid use may also be a contributing factor. Using large healthcare claims databases from 2000-2014, we compared individual- and household-level characteristics of 27 million new users of prescription painkillers who shared their health plan with one or more household members. Furthermore, we estimated 1-year risks of opioid use for 18 million household members of new prescription opioid versus non-opioid users using weighted Kaplan-Meier estimators. Finally, we used a novel instrumental variable approach comparing household members of ankle fracture versus sprain patients to isolate potential person-to-person influence of opioid use from social and behavioral commonalities of household members. New users of prescription opioids were more likely to have a household member with a history of prescription opioid use than new users of non-opioids. The 1-year risk of opioid initiation for household members of opioid users was 11.83% (95% CI, 11.81, 11.85) compared to 11.11% (95% CI, 11.09, 11.14) for household members of non-opioid users. Compared to non-opioids, opioids prescribed to one household member was associated with 0.71% (95% CI: 0.68, 0.74) higher 1-year risk of prescription opioid use in another household member. Fracture patients were more likely to receive opioids than sprain patients (30-day risk difference: 23%). The 1-year risk of opioid initiation for household members of ankle fracture patients was 11.5% compared to 11.8% for household members of ankle sprain patients. Household members of fracture patients were less likely to initiate opioids than household members of sprain patients (1-year risk difference: -0.26%; 95% CI: -0.30, -0.22). The 1-year instrumental variable risk difference was -1.13% (95% CI: -1.29, -0.97). Prevalent and incident use of prescription opioids appeared to cluster within households, which may be due to person-to-person influence or other commonalities within households. Understanding potential mechanisms underlying these household patterns may inform policies for drug prescribing and control measures.
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  • In Copyright
Advisor
  • Carey, Timothy
  • Brookhart, M. Alan
  • Westreich, Daniel
  • Wheeler, Stephanie
  • Cole, Stephen
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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