Household Exposure to Substance Abuse and the Risk of New Persistent Opioid Use After Cancer Surgery
Mujtaba Khalil
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorSelamawit Woldesenbet
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorShreya Shaw
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorShahzaib Zindani
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorZayed Rashid
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorAbdullah Altaf
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorRazeen Thammachack
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorSyed Husain
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorCorresponding Author
Timothy M. Pawlik
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Correspondence: Timothy M. Pawlik ([email protected])
Search for more papers by this authorMujtaba Khalil
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorSelamawit Woldesenbet
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorShreya Shaw
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorShahzaib Zindani
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorZayed Rashid
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorAbdullah Altaf
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorRazeen Thammachack
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorSyed Husain
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Search for more papers by this authorCorresponding Author
Timothy M. Pawlik
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
Correspondence: Timothy M. Pawlik ([email protected])
Search for more papers by this authorABSTRACT
Background
Household-level factors may also influence the risk of new persistent opioid use (NPOU). We sought to assess the risk of NPOU among individuals with household exposure to substance abuse.
Methods
Opioid-naïve individuals who underwent oncological procedures were identified using the IBM MarketScan database. Multivariable regression equations were used to assess the association between household exposure to substance abuse and NPOU.
Results
Among 10 557 individuals 4.9% (n = 520) had a family history of substance abuse. Patients with a family history of substance abuse were more likely to use opioids during the perioperative (85.0% vs. 78.8%) and postoperative periods (40.2% vs. 34.1%) (both p < 0.05). Moreover, perioperative (300 MME [IQR: 450–200] vs. 250 MME [IQR: 150–435]) and postoperative (525 MME [IQR: 1348–225] vs. 350 MME [IQR: 150–850]) opioid dose was also higher among patients with a family history of substance abuse (both p < 0.001). On multivariate analysis, patients with family history of substance abuse had 37% (OR 1.37, 95% CI 1.07–1.75) higher odds of NPOU.
Conclusion
Among opioid-naïve individuals undergoing oncological procedures, a family history of substance abuse is associated with NPOU. Patients should be screened for household-level factors before prescribing opioids for perioperative use.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
References
- 1D. Dowell, T. M. Haegerich, and R. Chou, “CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016,” Journal of the American Medical Association 315, no. 15 (2016): 1624–1645, https://doi.org/10.1001/jama.2016.1464.
- 2“U.S. Overdose Deaths In 2021 Increased Half as Much as in 2020—But Are Still Up 15%,” 2022, https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm.
- 3X. Zang, S. E. Bessey, M. S. Krieger, et al., “Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island,” JAMA Network Open 5, no. 11 (2022): e2241174, https://doi.org/10.1001/jamanetworkopen.2022.41174.
- 4C. S. Florence, C. Zhou, F. Luo, and L. Xu, “The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013,” Medical Care 54, no. 10 (2016): 901–906, https://doi.org/10.1097/MLR.0000000000000625.
- 5E. C. Serrell, C. C. Greenberg, and T. Borza, “Surgeons and Perioperative Opioid Prescribing: An Underappreciated Contributor to the Opioid Epidemic,” Cancer 127, no. 2 (2021): 184–187, https://doi.org/10.1002/cncr.33199.
- 6M. Khalil, S. Woldesenbet, M. M. Munir, et al., “Long-Term Health Outcomes of New Persistent Opioid Use After Gastrointestinal Cancer Surgery,” Annals of Surgical Oncology 31, no. 8 (2024): 5283–5292, https://doi.org/10.1245/s10434-024-15435-1.
- 7O. D. Lawal, J. Gold, A. Murthy, et al., “Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery: A Systematic Review and Meta-Analysis,” JAMA Network Open 3, no. 6 (2020): e207367, https://doi.org/10.1001/jamanetworkopen.2020.7367.
- 8R. K. Elmallah, P. N. Ramkumar, A. Khlopas, et al., “Postoperative Pain and Analgesia: Is There a Genetic Basis to the Opioid Crisis?,” Surgical Technology International 32 (2018): 306–314.
- 9E. L. Pestka, J. Craner, M. Evans, et al., “Impact of Family History of Substance Abuse on Admission Opioid Dose, Depressive Symptoms, and Pain Catastrophizing in Patients With Chronic Pain,” Pain Management Nursing 19, no. 2 (2018): 115–124, https://doi.org/10.1016/j.pmn.2017.09.007.
- 10M. S. Angst, N. G. Phillips, D. R. Drover, et al., “Pain Sensitivity and Opioid Analgesia: A Pharmacogenomic Twin Study,” Pain 153, no. 7 (2012): 1397–1409, https://doi.org/10.1016/j.pain.2012.02.022.
- 11C. Nielsen, G. Knudsen, and Ó. Steingrímsdóttir, “Twin Studies of Pain,” Clinical Genetics 82, no. 4 (2012): 331–340, https://doi.org/10.1111/j.1399-0004.2012.01938.x.
- 12B. McCrady, “The Role of the Family in Alcohol Use Disorder Recovery for Adults,” Alcohol Research: Current Reviews 41, no. 1 (2021): 6, https://doi.org/10.35946/arcr.v41.1.06.
- 13D. Mays, S. E. Gilman, R. Rende, G. Luta, K. P. Tercyak, and R. S. Niaura, “Parental Smoking Exposure and Adolescent Smoking Trajectories,” Pediatrics 133, no. 6 (2014): 983–991, https://doi.org/10.1542/peds.2013-3003.
- 14C. M. Brummett, J. F. Waljee, J. Goesling, et al., “New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults,” JAMA Surgery 152, no. 6 (2017): e170504, https://doi.org/10.1001/jamasurg.2017.0504.
- 15M. Khalil, S. Woldesenbet, M. M. Munir, et al., “Surgical Opioid Prescription and the Risk of Opioid Initiation Among Opioid-Naive Households,” American Journal of Surgery 241 (2025): 116029, https://doi.org/10.1016/j.amjsurg.2024.116029.
- 16A. M. Butler, K. B. Nickel, R. A. Overman, and M. A. Brookhart, “ IBM MarketScan Research Databases.” in Databases for Pharmacoepidemiological Research (Springer Series on Epidemiology and Public Health), eds. M. Sturkenboom and T. Schink. (Springer International Publishing, 2021), 243–251, https://doi.org/10.1007/978-3-030-51455-6_20.
10.1007/978-3-030-51455-6_20 Google Scholar
- 17M. Khalil, S. Woldesenbet, M. M. Munir, et al., “Healthcare Utilization and Expenditures Among Patients With Venous Thromboembolism Following Gastrointestinal Cancer Surgery,” Journal of Gastrointestinal Surgery 28, no. 7 (2024): 1151–1157, https://doi.org/10.1016/j.gassur.2024.05.012.
- 18M. Khalil, S. Woldesenbet, S. Iyer, et al., “Impact of Spousal Mental Illness on Healthcare Utilization Among Patients With Gastrointestinal Cancer,” Journal of Surgical Oncology. Published ahead of print, September 5, 2024, https://doi.org/10.1002/jso.27860.
- 19C. M. Harbaugh, J. S. Lee, K. P. Chua, et al., “Association Between Long-Term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults,” JAMA Surgery 154, no. 4 (2019): e185838, https://doi.org/10.1001/jamasurg.2018.5838.
- 20E. von Elm, D. G. Altman, M. Egger, S. J. Pocock, P. C. Gøtzsche, and J. P. Vandenbroucke, “The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies,” International Journal of Surgery 12, no. 12 (2014): 1495–1499, https://doi.org/10.1016/j.ijsu.2014.07.013.
- 21M. Li, C. Peterson, L. Xu, C. A. Mikosz, and F. Luo, “Medical Costs of Substance Use Disorders in the US Employer-Sponsored Insurance Population,” JAMA Network Open 6, no. 1 (2023): e2252378, https://doi.org/10.1001/jamanetworkopen.2022.52378.
- 22U. Waqar, M. M. M. Khan, S. Woldesenbet, et al., “Disparities in Liver Transplantation Rates and Outcomes Among Adults With and Without Mental Illnesses,” Journal of Gastrointestinal Surgery 27, no. 11 (2023): 2434–2443, https://doi.org/10.1007/s11605-023-05814-6.
- 23R. Howard, A. Ryan, H. M. Hu, et al., “Evidence-Based Opioid Prescribing Guidelines and New Persistent Opioid Use After Surgery,” Annals of Surgery 278, no. 2 (2023): 216–221, https://doi.org/10.1097/SLA.0000000000005792.
- 24H. Kehlet and J. P. Rathmell, “Persistent Postsurgical Pain: The Path Forward Through Better Design of Clinical Studies,” Anesthesiology 112, no. 3 (2010): 514–515, https://doi.org/10.1097/ALN.0b013e3181cf423d.
- 25R. L. Haffajee, M. M. Mello, F. Zhang, A. M. Zaslavsky, M. R. Larochelle, and J. F. Wharam, “Four States With Robust Prescription Drug Monitoring Programs Reduced Opioid Dosages,” Health Affairs 37, no. 6 (2018): 964–974, https://doi.org/10.1377/hlthaff.2017.1321.
- 26A. M. Dydyk, N. K. Jain, and M. Gupta, “ Opioid Use Disorder.” in StatPearls (StatPearls Publishing, 2024), http://www.ncbi.nlm.nih.gov/books/NBK553166/.
- 27V. Jairam, D. X. Yang, V. Verma, J. B. Yu, and H. S. Park, “National Patterns in Prescription Opioid Use and Misuse Among Cancer Survivors in the United States,” JAMA Network Open 3, no. 8 (2020): e2013605, https://doi.org/10.1001/jamanetworkopen.2020.13605.
- 28M. C. Bicket, J. J. Long, P. J. Pronovost, G. C. Alexander, and C. L. Wu, “Prescription Opioid Analgesics Commonly Unused After Surgery: A Systematic Review,” JAMA Surgery 152, no. 11 (2017): 1066–1071, https://doi.org/10.1001/jamasurg.2017.0831.
- 29P. C. Griesler, M. C. Hu, M. M. Wall, and D. B. Kandel, “Assessment of Prescription Opioid Medical Use and Misuse Among Parents and Their Adolescent Offspring in the US,” JAMA Network Open 4, no. 1 (2021): e2031073, https://doi.org/10.1001/jamanetworkopen.2020.31073.
- 30V. Martinez, H. Beloeil, E. Marret, D. Fletcher, P. Ravaud, and L. Trinquart, “Non-Opioid Analgesics in Adults After Major Surgery: Systematic Review With Network Meta-Analysis of Randomized Trials,” British Journal of Anaesthesia 118, no. 1 (2017): 22–31, https://doi.org/10.1093/bja/aew391.
- 31L. H. Khoury, J. Stephens, S. Brown, et al., “Application of Risk Assessment Tools to Predict Opioid Usage After Shoulder Surgery,” JSES International 6, no. 5 (2022): 833–842, https://doi.org/10.1016/j.jseint.2022.06.001.
- 32J. Klimas, L. Gorfinkel, N. Fairbairn, et al., “Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain: A Systematic Review,” JAMA Network Open 2, no. 5 (2019): e193365, https://doi.org/10.1001/jamanetworkopen.2019.3365.
- 33M. P. Botticelli and H. K. Koh, “Changing the Language of Addiction,” Journal of the American Medical Association 316, no. 13 (2016): 1361–1362, https://doi.org/10.1001/jama.2016.11874.
- 34X. Lv, H. Zhang, J. Gao, et al., “Intraoperative Dexmedetomidine on Postoperative Pain in Gastrointestinal Surgery: An Observational Study,” International Journal of Surgery 109, no. 4 (2023): 887–895, https://doi.org/10.1097/JS9.0000000000000360.
- 35A. N. Edinoff, D. Askins, E. Bobo, et al., “The Emerging Role of Ketamine in Acute Postoperative Pain Management,” Current Pain and Headache Reports 27, no. 9 (2023): 387–397, https://doi.org/10.1007/s11916-023-01134-1.