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

## TL;DR

This study finds that parental opioid prescriptions are linked to a higher risk of opioid use in adolescents and young adults, regardless of whether parents have chronic pain.

## Contribution

The study provides new evidence that parental opioid use is associated with increased opioid use in offspring, independent of parental chronic pain status.

## Key findings

- Offspring of parents with ≥2 opioid prescriptions had a significantly higher risk of persistent opioid use.
- The association remained even when accounting for parental chronic musculoskeletal pain status.
- Family-based strategies may be needed to manage opioid use in young people.

## Abstract

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.

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.

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.

Opioids are often prescribed for non-malignant pain despite potential adverse long-term consequences, particularly in young people.

This study examined whether parental use of prescription opioids is associated with increased risk of opioid use in their offspring.

This cohort study included 21,470 adolescents and young adults aged 13–29 years participating in the population-based Young-HUNT and HUNT Study in Norway paired with at least one parent. The Norwegian Prescription Registry was used to identify opioid prescriptions in parents and offspring.

Cox proportional hazard regression was used to estimate hazard ratios for opioid prescription in offspring according to mothers’ and fathers’ opioid prescriptions.

Offspring whose mother or father had two or more opioid prescriptions had higher risk of persistent opioid use in the subsequent 7 years compared to those whose parents did not receive any opioid prescription.

The study findings suggest that family-based strategies should be considered when managing pain conditions in adolescents and young adults to avoid potentially unnecessary opioid use.

Residual confounding due to unmeasured factors influencing both parental and offspring opioid prescriptions cannot be ruled out.

In a cohort study, Anna Marcuzzi and colleagues assessed the association between parental opioid prescriptions and risk of opioid use in the offspring, using a combination of survey and registry data from Norway.