Parental opioid prescriptions and the risk of opioid use in adolescents and young adults: The HUNT Study linked with prescription registry data

Abstract

Background Although opioids are usually not recommended for young people they are often prescribed. It is not clear whether family-level factors are related to the risk of opioid use among adolescents and young adults. The aim of this study is to examine the association between parental opioid prescriptions and risk of opioid use in young people. Methods and findings A prospective cohort study, including 21,470 adolescents and young adults (13–29 years) participating in the third (2006–2008) or fourth (2017–2019) survey of the population-based Young-HUNT or HUNT Study, Norway, paired with at least one participating parent. Opioid prescriptions were obtained by a linkage to the Norwegian Prescription Database. Parents’ opioid prescriptions were defined as ‘0’, ‘1’, and ‘≥2’ prescriptions over a period of 5 years. Analyses were also stratified according to parental chronic musculoskeletal (MSK) pain status (no, yes) assessed by the Standardised Nordic Questionnaire. Two outcomes were assessed: 1) any opioid prescription, and 2) persistent opioid prescriptions (i.e., at least three out of four quarters of the year). Analyses were adjusted for parental age, parental education level, parental body mass index, offspring age, and offspring participation survey. Follow-up started at the date of survey participation and ended at the date of prescription, emigration/death, or 7-year follow-up. If the mother or father had ≥2 opioid prescriptions, the hazard ratios (HR) for persistent opioid prescriptions in offspring were 2.60 (95% CI [1.86, 3.65]) and 2.37 (95% CI [1.56, 3.60]), respectively, compared to offspring whose parents did not receive any opioid prescriptions. There was no clear evidence that parental chronic MSK pain status influenced these associations. Comparing offspring of mothers with ≥2 versus no opioid prescriptions, the HR for any opioid prescription was 1.30 (95% CI [1.15, 1.47]) if the mother reported chronic MSK pain and 1.31 (95% CI [1.06, 1.62]) if she did not. Corresponding HRs associated with fathers’ opioid prescription were 1.19 (95% CI [1.01, 1.41]) if the father reported chronic MSK pain and 1.21 (95% CI [0.98, 1.50]) if he did not. Residual confounding due to unmeasured factors cannot be excluded. Conclusions Parental opioid prescription is related to an increased risk for opioid initiation and persistent use in offspring, irrespective of parental history of chronic MSK pain. These findings suggest that family-based strategies should be considered when managing pain and opioid use in young people.