Associations Between Opioid Prescribing Patterns and Overdose Among Privately Insured Adolescents

Area of Science:

• Public Health
• Pharmacology
• Adolescent Medicine

Background:

• Opioid prescriptions are common in adolescents, yet overdose risks remain poorly understood.
• Previous opioid use and its impact on overdose risk are critical areas for research.

Purpose of the Study:

• To assess the association between opioid characteristics (type, quantity, dose) and overdose risk in opioid-naive adolescents.
• To identify specific factors that may increase the likelihood of opioid overdose in this population.

Main Methods:

• Retrospective analysis of over 1.1 million privately insured adolescents (ages 11-17) using US claims data (2007-2015).
• Opioid overdose was identified through emergency, inpatient, or outpatient healthcare visits with a diagnosis of overdose.
• Statistical analysis examined the relationship between dispensed opioid quantity, dose, type, and overdose risk.

Main Results:

• 0.06% of adolescents experienced an opioid overdose, with a rate of 28 events per 100,000 patient-years.
• Receiving ≥30 opioid tablets increased overdose risk by 35% compared to ≤18 tablets (HR=1.35).
• Tramadol use was linked to a 2.67-fold higher overdose risk versus oxycodone (aHR=2.67); mental health conditions also elevated risk (HRs 1.65-3.09).

Conclusions:

• Opioid overdose can occur in previously opioid-naive adolescents, with a median time to event of 1.75 years.
• Higher dispensed tablet counts (>30), tramadol prescriptions, and pre-existing mental health conditions are significant risk factors for adolescent opioid overdose.