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Pain Med. 2018 Sep 10. doi: 10.1093/pm/pny179. [Epub ahead of print]

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

Author information

1
Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
2
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.
3
Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
4
Departments of Family Medicine, Internal Medicine, and the Oregon Institute for Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon, USA.

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 = 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] = 4.71, 95% confidence interval [CI] = 2.67-8.32, P < 0.001), post-traumatic stress disorder (AOR = 2.24, 95% CI = 1.14-4.38, P = 0.019), and bipolar disorder (AOR = 3.82, 95% CI = 1.49-9.81, P = 0.005). Past-year overlapping benzodiazepine and opioid prescriptions were associated with adverse outcomes, including a greater number of falls (risk ratio [RR] = 3.27, 95% CI = 1.77-6.02, P = 0.001) and emergency department visits (RR = 1.66, 95% CI = 1.08-2.53, P = 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.

PMID:
30204893
DOI:
10.1093/pm/pny179

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