Psychopathology and Opioid Analgesic Therapy among Adolescents and Young Adults: A Swedish Population Register-Based Study

• In Event: 1-008 - Using Administrative Data to Examine Development

Abstract

Although opioid analgesic prescription remains common among children and adolescents, the increasing prevalence of adverse opioid-related outcomes has raised concerns about their safety (Groenewald, Rabbitts, Gebert, & Palermo, 2016). For example, receipt of prescription opioids in youth is associated with subsequent opioid misuse, and there were 3.7 hospitalizations for prescription-opioid poisonings per 100,000 children in the US in 2012 (Gaither, Leventhal, Ryan, & Camenga, 2016; Miech, Johnston, O’Malley, Keyes, & Heard, 2015). Research using large-scale administrative healthcare data can help identify which youth are likely to be selected into opioid therapy for pain, thereby informing evaluations of real-world prescription practices and safety. In particular, studies of US commercial (i.e., private) healthcare insurance claims data show that adolescents and young adults with pre-existing psychopathology are more likely to receive opioids in greater quantity (e.g., Harbaugh et al., 2018; Quinn et al., 2017; Richardson et al., 2012). However, the extent to which psychopathology is associated with opioid receipt in other populations, such as youth with lower SES or those outside the US, is less well understood.

This study examined predictors of opioid receipt using data through 2014 from merged Swedish population registers, which contain nationwide information on dispensed prescriptions, other medical care, and other individual, familial, and socio-economic factors. Among prescription-opioid-naïve adolescents and young adults aged 13-29 years in 2007 (n = 1,494,756), 18.4% ever received opioids during follow-up. Among these recipients, 4.9% received long-term opioid therapy, which we defined as 2 or more strong opioid prescriptions dispensed within 6 months. Results extended prior findings regarding opioid prescription in the US. For example, we found that a wide range of pre-existing psychopathology was associated with opioid initiation, as well as the subsequent transition into long-term opioid therapy. Hazard ratios for associations with opioid initiation ranged from 1.12 (schizophrenia spectrum disorders; 95% CI, 1.04-1.21) to 2.31 (opioid use disorder; 95% CI, 2.10-2.55). Hazard ratios for subsequent long-term opioid therapy among those initiating receipt ranged from 1.73 (ADHD; 95% CI, 1.49-1.99) to 4.08 (opioid use disorder; 95% CI, 3.25-5.13). Thus, increased rates of long-term opioid receipt previously demonstrated among commercially insured US youth with pre-existing psychopathology were also present in a population-based Swedish cohort. These findings are consistent with the possibility that opioid prescription patterns among adolescents and young adults with psychopathology may reflect pain-psychopathology comorbidities, patient-provider interactions, or other underlying processes rather than specifics of commercially insured populations or the US opioid-prescribing environment.

Authors

• Patrick Quinn, Indiana University
  Presenting Author

• Martin Rickert, Indiana University

• Johan Franck, Karolinska Institutet

• Paul Lichtenstein, Karolinska Institute

• Henrik Larsson, Örebro University

• Brian D'Onofrio, Indiana University