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Erschienen in: Journal of General Internal Medicine 1/2020

12.11.2019

Patterns of Opioid and Benzodiazepine Use in Opioid-Naïve Patients with Newly Diagnosed Low Back and Lower Extremity Pain

verfasst von: Tej D. Azad, MS, Yi Zhang, AB, Martin N. Stienen, MD, Daniel Vail, BA, Jason P. Bentley, PhD, Allen L. Ho, MD, Paras Fatemi, MD, Daniel Herrick, MD, PhD, Lily H. Kim, BA, Austin Feng, BA, Kunal Varshneya, BA, Michael Jin, BA, Anand Veeravagu, MD, Jayanta Bhattacharya, MD, PhD, Manisha Desai, PhD, Anna Lembke, MD, John K. Ratliff, MD

Erschienen in: Journal of General Internal Medicine | Ausgabe 1/2020

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Abstract

Background

The morbidity and mortality associated with opioid and benzodiazepine co-prescription is a pressing national concern. Little is known about patterns of opioid and benzodiazepine use in patients with acute low back pain or lower extremity pain.

Objective

To characterize patterns of opioid and benzodiazepine prescribing among opioid-naïve, newly diagnosed low back pain (LBP) or lower extremity pain (LEP) patients and to investigate the relationship between benzodiazepine prescribing and long-term opioid use.

Design/Setting

We performed a retrospective analysis of a commercial database containing claims for more than 75 million enrollees in the USA.

Participants

Participants were adult patients newly diagnosed with LBP or LEP between 2008 and 2015 who did not have a red flag diagnosis, had not received an opioid prescription in the 6 months prior to diagnosis, and had 12 months of continuous enrollment after diagnosis.

Main Outcomes and Measures

Among patients receiving at least one opioid prescription within 12 months of diagnosis, we defined discrete patterns of benzodiazepine prescribing—continued use, new use, stopped use, and never use. We tested the association of these prescription patterns with long-term opioid use, defined as six or more fills within 12 months.

Results

We identified 2,497,653 opioid-naïve patients with newly diagnosed LBP or LEP. Between 2008 and 2015, 31.9% and 11.5% of these patients received opioid and benzodiazepine prescriptions, respectively, within 12 months of diagnosis. Rates of opioid prescription decreased from 34.8% in 2008 to 27.0% in 2015 (P < 0.001); however, prescribing of benzodiazepines only decreased from 11.6% in 2008 to 10.8% in 2015. Patients with continued or new benzodiazepine use consistently used more opioids than patients who never used or stopped using benzodiazepines during the study period (one-way ANOVA, P < 0.001). For patients with continued and new benzodiazepine use, the odds ratio of long-term opioid use compared with those never prescribed a benzodiazepine was 2.99 (95% CI, 2.89–3.08) and 2.68 (95% CI, 2.62–2.75), respectively.

Limitations

This study used administrative claims analyses, which rely on accuracy and completeness of diagnostic, procedural, and prescription codes.

Conclusion

Overall opioid prescribing for low back pain or lower extremity pain decreased substantially during the study period, indicating a shift in management within the medical community. Rates of benzodiazepine prescribing, however, remained at approximately 11%. Concurrent prescriptions of benzodiazepines and opioids after LBP or LEP diagnosis were associated with increased risk of long-term opioid use.
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Metadaten
Titel
Patterns of Opioid and Benzodiazepine Use in Opioid-Naïve Patients with Newly Diagnosed Low Back and Lower Extremity Pain
verfasst von
Tej D. Azad, MS
Yi Zhang, AB
Martin N. Stienen, MD
Daniel Vail, BA
Jason P. Bentley, PhD
Allen L. Ho, MD
Paras Fatemi, MD
Daniel Herrick, MD, PhD
Lily H. Kim, BA
Austin Feng, BA
Kunal Varshneya, BA
Michael Jin, BA
Anand Veeravagu, MD
Jayanta Bhattacharya, MD, PhD
Manisha Desai, PhD
Anna Lembke, MD
John K. Ratliff, MD
Publikationsdatum
12.11.2019
Verlag
Springer US
Erschienen in
Journal of General Internal Medicine / Ausgabe 1/2020
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-019-05549-8

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