Correlates of Benzodiazepine Use and Adverse Outcomes among Patients with Chronic Pain Prescribed Long-term Opioid Therapy

Bobbi Jo H. Yarborough, Scott P. Stumbo, Ashley Stoneburner, Ning Smith, Steven K. Dobscha, Richard A. Deyo, Benjamin J. Morasco

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1148-1155
Number of pages8
JournalPain Medicine (United States)
Volume20
Issue number6
DOIs
StatePublished - Jan 1 2019

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Benzodiazepines
Chronic Pain
Opioid Analgesics
Prescriptions
Odds Ratio
Confidence Intervals
Hospital Emergency Service
Therapeutics
Mental Disorders
Accidental Falls
Cross-Sectional Studies
Logistic Models
Veterans Health
Social Adjustment
Musculoskeletal Pain
Propensity Score
United States Department of Veterans Affairs
Health
Statistical Models
Post-Traumatic Stress Disorders

Keywords

  • Benzodiazepines
  • Co-Prescription
  • Emergency Department
  • Falls
  • Opioids

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Correlates of Benzodiazepine Use and Adverse Outcomes among Patients with Chronic Pain Prescribed Long-term Opioid Therapy. / Yarborough, Bobbi Jo H.; Stumbo, Scott P.; Stoneburner, Ashley; Smith, Ning; Dobscha, Steven K.; Deyo, Richard A.; Morasco, Benjamin J.

In: Pain Medicine (United States), Vol. 20, No. 6, 01.01.2019, p. 1148-1155.

Research output: Contribution to journalArticle

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abstract = "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.",
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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.

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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.

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