By Lisa Rapaport

Opioid overdoses may be much more likely to happen in families when somebody in the household has been prescribed these drugs, a U.S. study suggests.

Even when a family member gets lower doses of opioids – less than 50 morphine milligram equivalents per day – the overdose risk is almost three times higher than it would be in a family where nobody has been prescribed opioids, the study found.

The overdose risk was nearly 8 times greater when a family member was prescribed 50 to 90 morphine milligram equivalents a day; it was more than 15 times higher at doses above 90 morphine milligram equivalents per day.

“In the ongoing opioid crisis, much attention is focused on those who receive opioid prescriptions for themselves,” senior study author Joshua Gagne of Brigham and Women’s Hospital and Harvard Medical School in Boston told Reuters Health by email.

The new study shows these prescriptions are important risk factors for overdose for others in the household, he said, and overdose reduction and treatment strategies are needed for family members, too.

More than 42,000 people died from opioid overdoses in the U.S. in 2016 alone, Gagne and colleagues note in JAMA Internal Medicine. That year, approximately 11.5 million people misused opioid prescriptions, and more than 2 million individuals misused opioid prescriptions for the first time.

To reduce overdoses and deaths, many states have implemented programs to restrict and track opioid prescriptions, and some have also enacted or considered caps on the maximum daily doses that can be prescribed.

Still, when one person in a family gets prescribed opioids, the odds go up that another person in the same family will also take these drugs, the study team notes. And having more opioids in the house can make misuse and overdose more likely – especially when people hang on to any unused pills.

Patients who are prescribed opioids for acute pain should properly dispose of any leftover pills, Gagne said.

“Many pharmacies, health departments, police departments, and various healthcare facilities serve as safe disposal sites,” Gagne added. “When opioids are in the home, they should be stored in medication lock boxes, which are available at pharmacies and online retailers.”

His team’s findings are drawn from insurance claims data collected from 2004 to 2015 on 2,303 individuals who had an overdose and 9,212 who did not. This study wasn’t designed to prove whether or how opioid prescriptions within families might directly cause overdoses or deaths.

One limitation of the study is that researchers couldn’t tell whether any family members lived in different households, which might impact the availability of drugs. It also wasn’t clear if overdoses were from prescription opioids or illegal drugs like heroin.

Even so, the results underscore the need for precautions when opioids are prescribed, said Dr. Marc Larochelle of Boston University and the Grayken Center for Addiction at Boston Medical Center.

“These findings emphasize the importance of educating individuals and family members about the need to store these medications in a safe, secure manner as well as the risk from sharing medications,” LaRochelle, who wasn’t involved in the study, said by email. He has received research support from OptumLabs.

“The latter is very important as there are numerous potential drug interactions and other reasons why individuals may respond differently to the same dosage of opioids,” LaRochelle added. “What may be safe for the individual prescribed an opioid under a medical provider’s supervision may likely not be safe for family members.”

SOURCE: JAMA Internal Medicine, online June 24, 2019.