409 - Intoxication in Children of Family Members Prescribed Opioids: A Population-based Case-control Study in Denmark

Publication Number: 409.5443

YARON Finkelstein, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Szimonetta Komjáthiné Szépligeti, Department of Clinical Epidemiology, Aarhus, Midtjylland, Denmark; Erzsébet Horváth-Puhó, Aarhus University, Aarhus, Midtjylland, Denmark; Lars Pedersen, Boston University School of Medicine, Aarhus, Midtjylland, Denmark; Stephen Freedman, University of Calgary, Calgary, AB, Canada; Henrik Toft Sørensen, Aarhus University Hospital and Aarhus University, Aarhus, Midtjylland, Denmark; Eyal Cohen, The Hospital for Sick Children, Toronto, ON, Canada

Background: Worldwide, 350,000 deaths are attributable to opioids each year. The risk is unknown of downstream harm to children from opioids prescribed to family members.

Objective: To assess whether serious opioid intoxication event (SOE) in children is associated with increased odds of opioid prescription redemption by a family member.

Design/Methods: Methods: We conducted a population-based, case-control study over 27 years (1995–2022) across Denmark. Using Denmark’s national healthcare registries, we studied all residents < 20 years (cumulative: 3,761,618). SOEs were defined as death, hospitalization, or emergency department visit due to opioid intoxication. Cases were individuals who experienced SOE. Each case was matched to 10 population-based controls with no SOE. Exposure was defined as an analgesic prescription redemption by a household family member within three months preceding a Child’s SOE. We examined three exposure categories: children whose family members were exposed to prescription opioids, children whose family members were exposed to non-steroidal anti-inflammatory drugs (NSAIDs), and unexposed children (i.e., family members had not redeemed opioids or NSAIDs). We compared the odds of SOE in children whose family members redeemed an opioid prescription with that in children in unexposed households and in children with family members who redeemed NSAIDs. We used conditional logistic regression models to compute odds ratios (ORs), adjusted for sociodemographic and mental health covariates. Subsequently, we stratified the analyses by sex, age brackets ( < 13 vs. ≥13 years), and hospital disposition. Finally, we conducted a sensitivity analysis restricting the time interval between a redeemed prescription and SOE to one month.

Results: 2,000 children (54.8% males) experienced SOE and were matched to 19,840 controls. Among cases, 1,116 (55.8%) were hospitalized, and 60 (3.0%) died. A redeemed opioid prescription by a family member was associated with markedly increased odds of a child in the household experiencing an SOE (aOR: 2.87; 95%CI 2.45 to 3.38) and an even higher odds of death (aOR: 3.70; 95%CI 1.55 to 8.84) compared with a child from an unexposed family. Association with an increased SOE risk persisted, compared to children with a family member exposed to NSAIDs (aOR: 2.22; 95%CI 1.81 to 2.72) and in stratified and sensitivity analyses.

Conclusion(s): Children of family members prescribed opioids are at a markedly increased risk of opioid intoxication requiring hospital care or resulting in death compared to children of unexposed families and those exposed to non-opioid analgesics.

Figure:
forest_plot_Sept2024.pdfForest plot illustrating adjusted odds ratios of Serious Opioid Events (SOE) in children whose family members were prescribed opioids in the preceding three months versus in unexposed children (blue), or opioid-exposed versus NSAID-exposed (brown).