Jennifer Bethell1, Mark D Neuman2, Brian T Bateman3, Karim S Ladha4, Andrea Hill5, Guohua Li6, Duminda N Wijeysundera7, Hannah Wunsch8. 1. Sunnybrook Research Institute, ICES, the Toronto Rehabilitation Institute at the University Health Network, and the Institute of Health Policy Management and Evaluation at the University of Toronto, Toronto, Ontario. 2. The Department of Anesthesiology and Critical Care, the Center for Perioperative Outcomes Research and Transformation, and the Center for Pharmacoepidemiology Research and Training at the University of Pennsylvania Perelman School of Medicine, and the Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, Pennsylvania. 3. The Department of Anesthesia, Perioperative, and Pain Medicine, and the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 4. The Department of Anesthesia at St. Michael's Hospital, and the Department of Anesthesia at the University of Toronto, Toronto, Ontario. 5. Sunnybrook Research Institute, and the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario. 6. The Department of Epidemiology, Mailman School of Public Health, and the Department of Anesthesiology, College of Physicians and Surgeons at Columbia University, and the Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, New York. 7. ICES, the Institute of Health Policy Management and Evaluation and the Department of Anesthesia at the University of Toronto, and the Department of Anesthesia at St. Michael's Hospital, Toronto, Ontario. 8. Sunnybrook Research Institute, ICES, the Department of Anesthesia at the University of Toronto, the Department of Critical Care Medicine at the Sunnybrook Health Sciences Centre, and the Interdepartmental Division of Critical Care Medicine at the University of Toronto, Toronto, Ontario.
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). DISCUSSION: 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.
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). DISCUSSION: 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.
Entities:
Keywords:
adolescent; analgesics; child; drug overdose; opioid; prescription drug misuse; surgery; young adult
Authors: Hannah Wunsch; Andrea D Hill; Jennifer Bethell; Longdi Fu; Brian T Bateman; Karim S Ladha; Duminda N Wijeysundera; Mark D Neuman Journal: Ann Surg Date: 2021-11-23 Impact factor: 13.787