Receiving an Opioid Prescription Increases Opioid Use Disorder Risk by 7-Fold

Receipt of a single opioid prescription was found to result in a substantially increased risk of developing opioid use disorder (OUD) among the general population, according to results of a study published in Psychological Medicine.

A team of investigators sourced data for this study from national linked registries in Sweden. Individuals (N=1,516,392) born in Sweden between 1980 and 2000 were evaluated for receipt of an opioid prescription and subsequent OUD risk through 2017. To balance for cohort differences, propensity score matching and co-sibling analyses were performed.

A total of 335,833 individuals who received a first opioid prescription had sufficient data for this analysis. Among this group, 3034 developed OUD at an average of 3.41 (standard deviation [SD], 2.39) years after receipt of their first opioid prescription.

Risk for OUD after receipt of a first opioid prescription was substantially increased (hazard ratio [HR], 7.10), even after adjusting for gender, parental education, and personal education (adjusted HR [aHR], 5.81; 95% CI, 5.49-6.15). Refilling the first opioid prescription also increased the risk for OUD by 3.5-fold.

In general, men were diagnosed with OUD more quickly after receipt of a first opioid prescription than women (mean, 3.34 vs 3.53 years, respectively; P =.04).

Increased risk for OUD in the propensity-matched analysis was observed among individuals with a prior nonopioid drug use disorder (aHR, 4.44), depression or anxiety disorders (aHR, 1.99), criminal behavior (aHR, 1.78), prior alcohol use disorder (aHR, 1.42), bipolar or nonaffective psychotic disorders (aHR, 1.36), mid (aHR, 1.35) or low (aHR, 1.28) community deprivation compared with high deprivation, unmarried status (aHR, 1.29), and parental divorce or death (aHR, 1.09).

In the co-sibling analysis, prior alcohol use disorder, nonopioid drug use disorder, criminal behavior, depression or anxiety disorders, and bipolar or nonaffective psychotic disorders remained significant predictors of OUD following receipt of a first opioid prescription.

Investigators used 21 variables to establish weighted parameters for predicting OUD. Similar trends as in the multivariate logistic regression analysis were found, and 60% of all OUD cases were within the top decile of predicted risk. The prediction score had an area under the curve score of 0.85.

A limitation of this study is that its results may not be generalizable to a non-Swedish population.

These data indicate that after receipt of a first opioid prescription, individuals were at 7-fold increased risk of developing OUD. Significant predictors of risk included prior substance use, criminal behavior, and psychiatric conditions. The study authors conclude, “Our results document the public health importance of the substantial increase in OUD risk after [opioid prescription] and provide predictive models that permit clinicians to gauge, with at least moderate accuracy, individuals at particularly high risk for the development of OUD after [opioid prescription].”