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Risk factors for the development of opioid use disorder after first opioid prescription : a Swedish national study

Kendler, Kenneth S. ; Lönn, Sara L. LU ; Ektor-Andersen, John LU ; Sundquist, Jan LU and Sundquist, Kristina LU (2023) In Psychological Medicine 53(13). p.6223-6231
Abstract

Background We need to better understand the frequency and predictors of opioid use disorder (OUD) after first opioid prescription (OP). Methods We followed 1 516 392 individuals from the Swedish population born 1980-2000, from 1 July 2007, until 31 Dec 2017. We examined putative risk predictors with univariable and multivariable Cox Models and the potential causal effects of predictors by propensity score and co-sibling analyses. Result Of the individuals in our cohort, 24.8% (375 404) received a first OP, of whom 3034 (0.90%) developed a subsequent first OUD. The hazard ratio (HR) (± 95% CIs) for OUD after OP equaled 7.10 (6.75-7.46), with a mean time to onset of 3.41 (2.39) years. The strongest putative risk factors for development of... (More)

Background We need to better understand the frequency and predictors of opioid use disorder (OUD) after first opioid prescription (OP). Methods We followed 1 516 392 individuals from the Swedish population born 1980-2000, from 1 July 2007, until 31 Dec 2017. We examined putative risk predictors with univariable and multivariable Cox Models and the potential causal effects of predictors by propensity score and co-sibling analyses. Result Of the individuals in our cohort, 24.8% (375 404) received a first OP, of whom 3034 (0.90%) developed a subsequent first OUD. The hazard ratio (HR) (± 95% CIs) for OUD after OP equaled 7.10 (6.75-7.46), with a mean time to onset of 3.41 (2.39) years. The strongest putative risk factors for development of OUD after OP were prior psychiatric and substance use disorders, criminal behavior, parental divorce/death, poor school performance, current community deprivation, divorce, and male sex. Few predictors differed across sexes. OP renewal was associated with a HR of 3.66 (3.41-3.93) for OUD. Co-sibling and propensity score analyses suggested that at least a moderate proportion of the risk factor-OUD association was likely causal. A risk score to predict OUD after OP had an AUC of 0.85, where nearly 60% of cases scoring in the top decile. Conclusions In a general population sample, an OP represents a substantial risk factor for subsequent OUD. Many of the risk factors for OUD after OP can be readily assessed at the time of potential OP, permitting clinicians to evaluate the risk of iatrogenic OUD.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Follow-up study, opioid prescription, opioid use disorder, Sweden
in
Psychological Medicine
volume
53
issue
13
pages
9 pages
publisher
Cambridge University Press
external identifiers
  • pmid:36415073
  • scopus:85172425763
ISSN
0033-2917
DOI
10.1017/S003329172200349X
language
English
LU publication?
yes
id
225ccfa3-1ef3-4683-a911-b1d16a815005
date added to LUP
2023-12-08 10:40:26
date last changed
2024-04-21 04:37:48
@article{225ccfa3-1ef3-4683-a911-b1d16a815005,
  abstract     = {{<p>Background We need to better understand the frequency and predictors of opioid use disorder (OUD) after first opioid prescription (OP). Methods We followed 1 516 392 individuals from the Swedish population born 1980-2000, from 1 July 2007, until 31 Dec 2017. We examined putative risk predictors with univariable and multivariable Cox Models and the potential causal effects of predictors by propensity score and co-sibling analyses. Result Of the individuals in our cohort, 24.8% (375 404) received a first OP, of whom 3034 (0.90%) developed a subsequent first OUD. The hazard ratio (HR) (± 95% CIs) for OUD after OP equaled 7.10 (6.75-7.46), with a mean time to onset of 3.41 (2.39) years. The strongest putative risk factors for development of OUD after OP were prior psychiatric and substance use disorders, criminal behavior, parental divorce/death, poor school performance, current community deprivation, divorce, and male sex. Few predictors differed across sexes. OP renewal was associated with a HR of 3.66 (3.41-3.93) for OUD. Co-sibling and propensity score analyses suggested that at least a moderate proportion of the risk factor-OUD association was likely causal. A risk score to predict OUD after OP had an AUC of 0.85, where nearly 60% of cases scoring in the top decile. Conclusions In a general population sample, an OP represents a substantial risk factor for subsequent OUD. Many of the risk factors for OUD after OP can be readily assessed at the time of potential OP, permitting clinicians to evaluate the risk of iatrogenic OUD.</p>}},
  author       = {{Kendler, Kenneth S. and Lönn, Sara L. and Ektor-Andersen, John and Sundquist, Jan and Sundquist, Kristina}},
  issn         = {{0033-2917}},
  keywords     = {{Follow-up study; opioid prescription; opioid use disorder; Sweden}},
  language     = {{eng}},
  month        = {{10}},
  number       = {{13}},
  pages        = {{6223--6231}},
  publisher    = {{Cambridge University Press}},
  series       = {{Psychological Medicine}},
  title        = {{Risk factors for the development of opioid use disorder after first opioid prescription : a Swedish national study}},
  url          = {{http://dx.doi.org/10.1017/S003329172200349X}},
  doi          = {{10.1017/S003329172200349X}},
  volume       = {{53}},
  year         = {{2023}},
}