Abstract

Background

Postoperative opioid prescriptions may be associated with risks of unintentional poisoning and drug diversion in other household members. The objective of this study was to explore the association between mothers’ postoperative opioid prescriptions and incidence of opioid-related events in their children (aged 1 to 24 years).

Data and methods

This retrospective cohort study used individually linked administrative health data from Ontario, Canada. A population-based sample of 170,156 opioid-naïve mothers (aged 15 to 64) (see Figure 1) who underwent surgery between 2013 and 2017 in Ontario was linked through birth records to create a cohort of their 283,550 opioid-naïve children (aged 1 to 24). The association between postoperative opioid analgesic prescriptions filled by mothers within seven days of discharge after surgery and opioid-related events (emergency department presentations or inpatient admissions for opioid poisoning, or mental and behavioural disorders attributable to opioid use) in their children within one year of their mother’s discharge was assessed.

Results

Overall, 60.4% of the children in the cohort had a mother who filled a postoperative opioid prescription. The incidence of opioid-related events in children in the year after a mother’s surgery was low overall (n=36/283,550, 0.01%), but higher among children whose mother filled a postoperative opioid prescription (n=29/171,139, 0.02%, vs. n=7/112,411, 0.01%, p=0.02), including in an analysis adjusting for child’s age, mother’s age, rural residence, neighbourhood income quintile and mother’s Charlson comorbidity index score (adjusted odds ratio, 2.42 [95% confidence interval (CI), 1.05 to 5.54], p=0.04).

Interpretation

Postoperative opioid prescriptions for mothers may contribute to opioid-related events in their children. These findings further underscore the importance of safe, effective opioid prescribing, as well as of patient and public education about the use, storage and disposal of these medications.

Keywords

surgery, analgesics, opioid, child, adolescent, young adult, prescription drug misuse, drug overdose

DOI: https://www.doi.org/10.25318/82-003-x202000600002-eng

Findings

In Ontario, in 2017, there were 1,276 emergency department visits for opioid poisoning among people younger than 25. Among those aged 15 to 24, the rate more than doubled between 2013 and 2017. Both Canadian and American data suggest that people younger than 25 may be experiencing disproportionate opioid-related harms. This age group makes up roughly 1 in 10 of those who were dispensed an opioid, but accounts for 1 in 5 emergency department presentations for opioid poisoning. This difference may be related, in part, to illicit opioid use, but evidence also supports another explanation—that some youth access opioids that have been prescribed to others in the household. Survey data from both countries show that, among youth who use opioids, the most common source of these opioids was family or friends. Two case–control studies (also from Canada and the United States) have shown that opioid prescriptions to family members are associated with an increased risk of hospital-treated overdoses in children and young adults. [Full article]

Authors

Jennifer Bethell (jennifer.bethell@uhn.ca), Andrea Hill and Hannah Wunsch are with the Sunnybrook Research Institute in Toronto, Ontario. Jennifer Bethell and Hannah Wunsch are also with ICES—formerly the Institute for Clinical Evaluative Sciences—in Toronto, as is Duminda N. Wijeysundera. Jennifer Bethell is also with the Toronto Rehabilitation Institute at the University Health Network in Toronto. Mark D. Neuman is with the Department of Anesthesiology and Critical Care at the University of Pennsylvania Perelman School of Medicine in Philadelphia, Pennsylvania. Brian T. Bateman is with the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women’s Hospital and with Harvard Medical School in Boston, Massachusetts. Karim S. Ladha is with the Department of Anesthesia at both St. Michael’s Hospital in Toronto and the University of Toronto, as is Duminda N. Wijeysundera. Andrea Hill and Hannah Wunsch are also with the Department of Critical Care Medicine at Sunnybrook Health Sciences Centre in Toronto. Guohua Li is with the Department of Epidemiology at the Mailman School of Public Health and the Department of Anesthesiology, Vagelos College of Physicians and Surgeons, at Columbia University in New York, New York. Hannah Wunsch is also with the Department of Anesthesia and the Interdepartmental Division of Critical Care Medicine at the University of Toronto.

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