Addictive painkillers that are continuously refilled within the first 90 days can be misused by a patient’s family, a new study shows.
When opioids are prescribed by physicians after surgeries, this can increase the risk of addiction in a patient to which they’ve been prescribed. Moreover, if patients do not complete the full round of post-treatment pain management and opioid drugs are left in the home, or if prescriptions continue to be refilled, these drugs can easily be used by another family member. New research from the Harvard Medical School, Boston, Massachusetts, takes a look at specifically how postsurgical opioid refills may or may not be associated with an increased risk for opioid misuse among family members.
Not only is opioid use after surgery posing a risk for patients who are susceptible to becoming addicted, but the Harvard team found that the likelihood of a family member misusing these drugs “increased 2.5 times” when prescriptions were refilled up to the max number of times allotted. The findings were published online July 15 in JAMA Network Open.
“Patients requiring ongoing opioid refills should set off alarm bells,” said study investigator Gabriel A. Brat, MD, assistant professor of surgery at Beth Israel Deaconess Medical Center and instructor in biomedical informatics at Harvard Medical School, Boston, Massachusetts. “It should prompt providers to ask themselves if the patient’s course of management needs to be adjusted because the opioids aren’t providing the recovery they’d like, or if by continuing on the existing course of refills they’re putting the family at risk.”
This isn’t the first study to link opioid prescriptions to misuse in discharged surgical patients. However, the Harvard team was more interested in determining just how likely it is for families of these patients to become addicted. “We were interested in understanding if that exposure was also impacting the family,” explained Brat.
The current study included patients and family members from an administrative database for a commercial insurance provider that stores data on more than 35 million people. Participants were receiving health and pharmacy insurance coverage from this provider. The team reviewed all opioid prescriptions filled and refilled by a patient up to 90 days post-surgery with multiple measures of opioid exposure for the patient being considered, including number of opioid refills and long-term exposure to opioids (longer than 90 days).
Family members “were aged 15-64 years and mainly included spouses, children, and parents,” they outlined in their paper. “Outcomes for family members were opioid misuse (defined as dependence, abuse, or overdose) and chronic opioid use longer than 90 days in the 12 months following the patient’s date of surgery.”
The analysis included “843,531 unique pairs of a patient and family member. Most pairs comprised female patients (52.8%) and male family members (52.5%), with many pairs that had patients aged 45-54 (29.6%) and with family members aged 15-24 (37.2%).”
The team concluded “about 36% of pairs were in households with no opioid prescriptions, and 47.1% were in households where the patient received only one initial opioid prescription. In 16.9% of pairs, the patients obtained at least one refill…There were 3894 opioid misuse events (0.5%) and 7485 chronic opioid use events (0.9%) in family members.”
Overall, they reported that filling only one round of opioids did not increase the probability of a family member misusing the medication. However, continually filling opioid prescriptions up to the 90 day mark was associated with greater risk for misuse.