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Impact of opioids on substance-related morbidity

Opioids are linked to substance-related morbidity and a new study looks at what morbidity looks like in adolescents and young adults.

Indiscriminate opioid prescriptions have spurred the ongoing opioid epidemic, which remains one of the biggest non-COVID-19 public health crises of the 21st century, and the epidemic has touched adolescents and young adults. An investigation in JAMA Pediatrics examines how opioid prescriptions in adolescence or young adulthood could impact the risk of substance-related morbidity.1

Investigators used population register data from January 2007 to December 2013. The data covered Swedish people aged 13 to 29 years who were opioid-naïve when they were given an opioid prescription. They compared opioid prescription recipients with people who were given nonsteroidal anti-inflammatory drugs. They also compared twins or other multiple birth individuals who were given opioid prescriptions with a co-multiple birth offspring who had not been given an opioid.

In the cohort of 1,541,862 people, 193,922 people had started an opioid prescription by December 2013. The active comparator part of the study included 77,143 people who were given opioids who did not have a preexisting substance-related morbidity and 229,461 people who were given nonsteroidal anti-inflammatory drug. Overall in the cohort, the adjusted cumulative incidence of morbidity related to substances within 5 years was 6.2% for people who were given opioids and 4.9% who were given nonsteroidal anti-inflammatory drugs. Within the co-twin control design, comparable results were seen. It was also seen when restricted to analgesics that were prescribed for dental indications, which are common indications for opioid prescriptions.

The researchers concluded that an initial opioid prescription was linked with a roughly 30% to 40% relative increase in the risk of subsequent-related morbidity. The increase was seen across different study designs. They said that the findings indicated that the increase could be smaller than had been seen in other studies trying to estimate the effects.


1. Quinn P, Fine K, Rickert M, et al. Association of opioid prescription initiation during adolescence and young adulthood with subsequent substance-related morbidity. JAMA Pediatr. August 11, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.2539