TY - JOUR
T1 - Correlates of Benzodiazepine Use and Adverse Outcomes among Patients with Chronic Pain Prescribed Long-term Opioid Therapy
AU - Yarborough, Bobbi Jo H.
AU - Stumbo, Scott P.
AU - Stoneburner, Ashley
AU - Smith, Ning
AU - Dobscha, Steven K.
AU - Deyo, Richard A.
AU - Morasco, Benjamin J.
N1 - Funding Information:
Funding sources: National Institute on Drug Abuse (grant number DA034083).
Funding Information:
Conflicts of interest: Unrelated to the current study, BJHY and SPS have received research contracts to their institution from the Industry post-marketing requirements (PMR), a consortium of companies conducting Food and Drug Administration–required postmarketing studies assessing risks related to opioid analgesics; they have also received research grants to their institution from the National Institutes of Health (NIH) and the Kaiser Permanente Community Benefit Initiative. SPS has received research funding from the Maternal and Child Health Bureau. RAD receives royalties from UpToDate for authoring topics on low back pain. Part of his salary has come from an endowment to Oregon Health & Science University from Kaiser Permanente. He has had support from federal grants to his university from the NIH, Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, and Patient-Centered Outcomes Research Institute. No other author reports having any potential conflict of interest with this study.
Publisher Copyright:
VC 2018 American Academy of Pain Medicine. All rights reserved.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Objective. To examine the correlates and odds of receiving overlapping benzodiazepine and opioid prescriptions and whether co-prescription was associated with greater odds of falling or visiting the emergency department. Design. Cross-sectional study. Setting. A large private integrated health system and a Veterans Health Administration integrated health system. Subjects. Five hundred seventeen adults with musculoskeletal pain and current prescriptions for long-term opioid therapy. Methods. A multivariate logistic regression model examined correlates of having overlapping benzodiazepine and opioid prescriptions in the year before enrollment in the cross-sectional study. Negative binomial models analyzed the number of falls in the past three months and past-year emergency department visits. In addition to propensity score adjustment, models controlled for demographic characteristics, psychiatric diagnoses, medications, overall comorbidity score, and opioid morphine equivalent dose. Results. Twenty-five percent (N ¼ 127) of participants had co-occurring benzodiazepine and opioid prescriptions in the prior year. Odds of receiving a benzodiazepine prescription were significantly higher among patients with the following psychiatric diagnoses: anxiety disorder (adjusted odds ratio [AOR] ¼ 4.71, 95% confidence interval [CI] ¼ 2.67–8.32, P < 0.001), post-traumatic stress disorder (AOR ¼ 2.24, 95% CI ¼ 1.14–4.38, P ¼ 0.019), and bipolar disorder (AOR ¼ 3.82, 95% CI ¼ 1.49–9.81, P ¼ 0.005). Past-year overlapping benzodiazepine and opioid prescriptions were associated with adverse outcomes, including a greater number of falls (risk ratio [RR] ¼ 3.27, 95% CI ¼ 1.77–6.02, P ¼ 0.001) and emergency department visits (RR ¼ 1.66, 95% CI ¼ 1.08–2.53, P ¼ 0.0194). Conclusions. Among patients with chronic pain prescribed long-term opioid therapy, one-quarter of patients had co-occurring prescriptions for benzodiazepines, and dual use was associated with increased odds of falls and emergency department visits.
AB - Objective. To examine the correlates and odds of receiving overlapping benzodiazepine and opioid prescriptions and whether co-prescription was associated with greater odds of falling or visiting the emergency department. Design. Cross-sectional study. Setting. A large private integrated health system and a Veterans Health Administration integrated health system. Subjects. Five hundred seventeen adults with musculoskeletal pain and current prescriptions for long-term opioid therapy. Methods. A multivariate logistic regression model examined correlates of having overlapping benzodiazepine and opioid prescriptions in the year before enrollment in the cross-sectional study. Negative binomial models analyzed the number of falls in the past three months and past-year emergency department visits. In addition to propensity score adjustment, models controlled for demographic characteristics, psychiatric diagnoses, medications, overall comorbidity score, and opioid morphine equivalent dose. Results. Twenty-five percent (N ¼ 127) of participants had co-occurring benzodiazepine and opioid prescriptions in the prior year. Odds of receiving a benzodiazepine prescription were significantly higher among patients with the following psychiatric diagnoses: anxiety disorder (adjusted odds ratio [AOR] ¼ 4.71, 95% confidence interval [CI] ¼ 2.67–8.32, P < 0.001), post-traumatic stress disorder (AOR ¼ 2.24, 95% CI ¼ 1.14–4.38, P ¼ 0.019), and bipolar disorder (AOR ¼ 3.82, 95% CI ¼ 1.49–9.81, P ¼ 0.005). Past-year overlapping benzodiazepine and opioid prescriptions were associated with adverse outcomes, including a greater number of falls (risk ratio [RR] ¼ 3.27, 95% CI ¼ 1.77–6.02, P ¼ 0.001) and emergency department visits (RR ¼ 1.66, 95% CI ¼ 1.08–2.53, P ¼ 0.0194). Conclusions. Among patients with chronic pain prescribed long-term opioid therapy, one-quarter of patients had co-occurring prescriptions for benzodiazepines, and dual use was associated with increased odds of falls and emergency department visits.
KW - Benzodiazepines
KW - Co-Prescription
KW - Emergency Department
KW - Falls
KW - Opioids
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U2 - 10.1093/pm/pny179
DO - 10.1093/pm/pny179
M3 - Article
C2 - 30204893
AN - SCOPUS:85072310526
SN - 1526-2375
VL - 20
SP - 1148
EP - 1155
JO - Pain Medicine
JF - Pain Medicine
IS - 6
ER -