PR1-158
Associations between opioid prescribing patterns and opioid overdose among adolescents in the USA.
1Groenewald C, 2Van Cleve W
1Seattle Children's Hospital, Seattle, WA, USA; 2University of Washington, Seattle, WA, USA
Background: Prescription opioid overdose is a serious public health concern affecting adolescents in the United States. Yet it is unknown whether individual differences in opioid prescribing, such as number of opioid tablets prescribed or type of opioid prescribed, are independent predictors of opioid overdose among adolescents. This is a major gap in knowledge that, if addressed, would provide important information on the risks and benefits associated with opioid prescribing to adolescents in the United States.
Methods: We performed secondary analyses of data from the Truven Health MarketScan Commercial Clams and Encounters database for the years 2007-2014, which contains information on a large commercially insured sample of adolescents (>1.2 million) who received opioids. The primary predictor variable was number of opioid tablets prescribed to opioid-naïve adolescents 10-18 years of age. The primary outcome variable was an opioid overdose event following an opioid prescription. Sociodemographic (age, gender, region), and type of opioid were also assessed. Cox proportional hazard models, controlling for age, gender, and region were used to determine associations between type of opioid and number of tablets prescribed and the risk for opioid overdose.
Results: We found that 4 out of every 10, 000 adolescent opioid users experienced an opioid overdose event, which corresponds to an overall rate of 0.04%. Risk for opioid overdose events in adjusted Cox proportional hazards regression increased by 1.53 (95% CI: 1.18-1.99; p<0.05) fold if adolescents received >30 pills at their first prescription, and by 2.9 (95% CI: 2.1-4.0), p<0.001 fold if they received tramadol (as compared to hydrocodone). Male sex (HR=0.6; 95% CI: 0.5-0.8) and younger age (HR=0.9; 95% CI: 0.8-0.95) was associated with a decreased risk for overdose.
Conclusions: Associations between patterns of opioid prescribing and risk for overdose highlight the need for guidelines aimed at reducing problematic opioid use among adolescents in the United States. Future research should extend this data to include publically insured and uninsured adolescents
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