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Baumann-Larsen M, Storheim K, Stangeland H, Zwart JA, Wentzel-Larsen T, Skurtveit S, Dyb G, Stensland SØ. Childhood trauma and the use of opioids and other prescription analgesics in adolescence and young adulthood: The HUNT Study. Pain 2024; 165:1317-1326. [PMID: 38126936 PMCID: PMC11090031 DOI: 10.1097/j.pain.0000000000003131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023]
Abstract
ABSTRACT Opioid and nonopioid analgesics are commonly prescribed to young people to alleviate pain. Even short-term prescriptions increase the risk of persistent use and future misuse of potent analgesics, such as opioids. Childhood trauma exposure has been found to be related to pain conditions and to using more prescription analgesics. This large, prospective cohort study aimed to investigate the association of a broad range of childhood trauma exposures with prescription rates for opioid and nonopioid analgesics in adolescence and young adulthood. Self-reported data on childhood trauma exposures from adolescents (aged 13-19 years) who participated in the Young-HUNT3 Study (2006-2008, n = 8199) were linked to data from the Norwegian Prescription Database (NorPD, 2004-2021). We found that exposure to childhood trauma was consistently associated with higher prescription rates for opioids throughout adolescence and young adulthood. The highest incidence rate ratio (IRR) in adolescence was observed for sexual abuse (IRR 1.63, confidence interval [CI] 1.19-2.23). In young adulthood, the highest IRR was observed for physical violence (2.66, CI 2.27-3.12). The same overall pattern was observed for nonopioid analgesics. The more frequent prescriptions of opioid and nonopioid analgesics to participants exposed to childhood trauma suggests a higher symptom load of pain causing them to seek professional help with pain relief. Receiving potent analgesics is not without risk, and the likelihood of misuse may be elevated among trauma-exposed individuals. A trauma-informed approach to pain could be vital for guiding clinicians to the most effective and least harmful treatment for each patient.
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Affiliation(s)
- Monica Baumann-Larsen
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjersti Storheim
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Helle Stangeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - John-Anker Zwart
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Svetlana Skurtveit
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Grete Dyb
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Synne Øien Stensland
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Sheehy O, Eltonsy S, Hawken S, Walker M, Kaul P, Winquist B, Barrett O, Savu A, Dragan R, Pugliese M, Bernatsky S, Gorgui J, Bérard A. Health Canada advisory impacts on the prevalence of oral codeine use in the Pediatric Canadian population: comparative study across provinces. Sci Rep 2024; 14:5370. [PMID: 38438444 PMCID: PMC10912710 DOI: 10.1038/s41598-024-55758-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
Health Canada (HC) has, since 2013, issued safety alerts restricting the use of codeine-containing drugs among breastfeeding women and children/adolescents under 18 years of age. These products are linked to breathing problems among ultra-rapid CYP2D6 metabolizers and early use of opioid can lead to future opioid misuse. Using a multi-province population-based cohort study, we estimate the impact of federal safety alerts on annual rates of codeine use in the Canadian pediatric population. We analyzed data from 8,156,948 children/adolescents in five Canadian provinces between 1996 and 2021, using a common protocol. Children/adolescents were categorized as: ≤ 12 years (children) or > 12 years (adolescents). We defined codeine exposure by ≥ 1 prescription filled for codeine alone or combined with other medications. For both age categories, we obtained province-specific codeine prescription filling rates per calendar year by dividing the number of children/adolescents with ≥ 1 codeine prescription filled by the number of person-time. Annual rates of codeine use per 1000 persons vary by province from 3.0 (Quebec) to 10.1 (Manitoba) in children, and from 5.5 to 51.3 in adolescents. After the 2013 HC advisory, exposure decreased in all provinces (adjusted level change from - 0.6 to - 18.4%) in children and from - 2.1 to - 17.9% in adolescents after the 2016 advisory. Annual rates declined over time in all provinces, following HC safety alerts specific to each of the two age categories.
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Affiliation(s)
- O Sheehy
- CHU Sainte-Justine, Research Center, 3175, Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - S Eltonsy
- Rady Faculty, College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
| | - S Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Scholl of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- ICES, Ottawa, ON, Canada
| | - M Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Scholl of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Better Outcomes Registry and Network (BORN) Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Departement of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
- International and Global Health Office, University of Ottawa, Ottawa, ON, Canada
| | - P Kaul
- Department of Medicine Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - B Winquist
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - O Barrett
- Data and Analytics, Alberta Health Services, Calgary, AB, Canada
| | - A Savu
- Department of Medicine Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - R Dragan
- Manitoba Centre for Health Policy, Winnipeg, MB, Canada
| | - M Pugliese
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, ICES uOttawa, Ottawa, ON, Canada
| | - S Bernatsky
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - J Gorgui
- CHU Sainte-Justine, Research Center, 3175, Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - A Bérard
- CHU Sainte-Justine, Research Center, 3175, Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.
- Faculty of Medicine, Université Claude Bernard Lyon 1, Lyon, France.
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