Family history is a risk factor for long-term opioid use

Dentists may want to ask about family members' opioid use before prescribing an opioid to a patient for oral surgery. Adolescents with persistent opioid use were nearly twice as likely to have a family member who also used opioids regularly in a new study, published on February 27.

The study included hundreds of thousands of adolescents and young adults who were prescribed an opioid for surgical tooth extraction, tonsillectomy, or another common surgical procedure. Genetic and environmental factors may be responsible for the familial association, according to the researchers.

"It is possible that long-term opioid use in family members may indicate the presence of shared genetic polymorphisms associated with chronic pain, opioid metabolism phenotypes, or neurochemical signaling pathways associated with opioid dependence," wrote the study authors, led by Calista Harbaugh, MD, a surgical resident at the University of Michigan in Ann Arbor (JAMA Surgery, February 27, 2019). "In addition, families may share environmental exposures or attitudes toward pain management and opioid use that increase the risk of persistent opioid use when adolescents and young adults are exposed to opioids."

Family history and individual risk

Previous studies have established that an individual's history of substance use disorder is associated with an increased risk for also developing opioid use disorder. However, few researchers have investigated whether family persistent opioid use influences a patient's risk of misusing or abusing opioids.

Therefore, the researchers conducted a study looking at persistent opioid use among 13- to 21-year-old patients undergoing dental extractions or another common type of surgery. These patients were considered opioid-naive, meaning they had not filed a prescription for opioids in the year before the surgery. They used deidentified private insurance claims data for these patients and their family members between January 2009 and December 2016.

About 74% of the 346,000 patients included in the study were prescribed an opioid in the days immediately before or after surgery. Three to six months later, 2.4% of these patients without a family member who persistently used opioids continued to fill an opioid prescription (see chart below). That number jumped to 4.1% for patients with at least one parent with long-term opioid use.

In addition, adolescents and young adults with family members who persistently used opioids were more likely to be prescribed an initial opioid prescription. They were also more likely to have been previously diagnosed with chronic pain and mental health disorders.

"In this study of more than 300,000 adolescents and young adults undergoing common surgical and dental procedures across all geographic regions, having a family member with long-term opioid use was associated with a higher probability of persistent opioid use," the authors wrote. "Long-term opioid use in family members was associated with a substantial increase in initial opioid prescription fills and postoperative opioid refills, even after adjustment for patient and family member comorbidities."

New screening tools needed

The authors cautioned that they were not able to determine whether the prescribed opioids were actually used by the patient undergoing surgery, as opposed to being used by a friend or someone else in the household. In addition, they could not account for opioids paid for out of pocket, reimbursed by a secondary insurance plan, filled by someone not enrolled in the patient's insurance, or acquired from a nonmedical source.

Nevertheless, the study results suggest there is a need to ask about family opioid use when prescribing opioids to adolescents and young adults. However, that may be difficult since many screening questionnaires and tools do not ask about family history or are not validated for this age range.

The authors called on researchers, policymakers, and the medical community to develop new screening tools that include family and environmental risk factors. They also asked dentists and other practitioners to carefully and sensitively ask about familial opioid use.

"Among adolescents and young adults undergoing common surgical and dental procedures, long-term opioid use among family members appears to be associated with persistent opioid use," the authors concluded. "Our findings suggest that, during the preoperative evaluation, practitioners should screen young patients undergoing procedures for long-term opioid use in their families and implement heightened efforts to prevent opioid dependence among patients with this important risk factor."