Parental opioid use may increase risk for suicidality among offspring, according to results from a pharmacoepidemiologic study published in JAMA Psychiatry.
Investigators abstracted data from the MarketScan Commercial Claims and Encounters databases, which comprise inpatient, outpatient, and prescription claims from more than 100 insurers in the United States. Parents age 30 to 50 years who received more than 365 days of opioid medication from January 1, 2010, to December 31, 2016, were matched by demographic features and concomitant psychotropic medication use with parents who did not have opioid prescription claims. Propensity score matching yielded 121,306 parental pairs; their children were included in analyses if they were between 10 and 15 years of age at the opioid index date of the parent using opioids in each matched pair. Children were followed until first suicide attempt or the end of data collection in 2016. Rates of child suicide attempts between the opioid and nonopioid matched cohorts were compared using generalized estimating equations.
The final study cohort comprised 148,395 children (50.9% boys; mean [SD] age 11.5 [1.6] years at start of follow-up) of parents who did not use opioids and 184,142 children (51.5% boys; mean [SD] age 11.8 [1.8] years at start of follow-up) of parents who used opioids. Children of parents with opioid use had a 2-fold increased risk for suicide attempts compared with children of matched controls, with rates of 11.68 vs 5.87 per 10,000 person-years (odds ratio [OR], 1.99; 95% CI, 1.71-2.33). This association remained significant in models adjusted for child age and sex (OR, 1.85; 95% CI, 1.58-2.17), child and parental depression or substance use disorder (OR, 1.46; 95% CI, 1.24-1.72), and parental history of suicide attempt (OR, 1.45; 95% CI, 1.23-1.71). The association also remained significant after adjustments for geographic variability in opioid use (OR, 2.00; 95% CI, 1.71-2.34).
As a result of these findings, investigators advocated for the inclusion of parental opioid use in mental health screening tools for children. Although medical claims data captured opioid use, few diagnoses of opioid use disorder were made in the parental cohort, suggesting a need for improved surveillance. Further research on opioid use disorder in parents and its impact on offspring is necessary to improve treatment resources for families affected by opioid use.
Brent DA, Hur K, Gibbons RD. Association between parental medical claims for opioid prescriptions and risk of suicide attempt by their children [published online May 22, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.0940