Advertisement

Trends in Co-Prescribing of Opioids and Opioid Potentiators Among U.S. Adults, 2007–2018

  • Taeho Greg Rhee
    Correspondence
    Address correspondence to: Taeho Greg Rhee, PhD, MSW, Department of Public Health Sciences, School of Medicine, University of Connecticut, 263 Farmington Avenue, Farmington CT 06030.
    Affiliations
    Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut

    Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
    Search for articles by this author
  • Donovan T. Maust
    Affiliations
    Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan

    Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan

    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
    Search for articles by this author
  • David A. Fiellin
    Affiliations
    Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut

    Program in Addiction Medicine, Yale School of Medicine, New Haven,Connecticut

    Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
    Search for articles by this author
  • Mark Olfson
    Affiliations
    Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
    Search for articles by this author
Published:November 13, 2020DOI:https://doi.org/10.1016/j.amepre.2020.09.007
      Several factors influence the risk of harms associated with prescription opioids.
      National Academies of Sciences, Engineering, and Medicine
      Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use.
      One modifiable factor is the co-prescription of medications such as benzodiazepines, nonbenzodiazepine sedative hypnotics, and gabapentinoids, which potentiate opioids’ respiratory depressant effects,
      • Vijay A
      • Ross JS
      • Shah ND
      • Jeffery MM
      • Dhruva SS
      Medicare formulary coverage and restrictions for opioid potentiators from 2013 to 2017.
      ,
      U.S. Food & Drug Administration
      FDA requires strong warnings for opioid analgesics, prescription opioid cough products, and benzodiazepine labeling related to serious risks and death from combined use.
      slowing breathing and increasing risk of accidental overdose.
      Centers for Medicare and Medicaid Services
      Reduce risk of opioid overdose deaths by avoiding and reducing co-prescribing benzodiazepines.
      Co-prescribing of benzodiazepines and opioids decreased after the U.S. Food and Drug Administration (FDA) black box warning of 2016.
      • Zhang VS
      • Olfson M
      • King M
      Opioid and benzodiazepine coprescribing in the United States before and after U.S. Food and Drug Administration boxed warning.
      However, it is unknown how the co-prescription of opioids with other respiratory depressant potentiators has changed recently.
      U.S. Food and Drug Administration
      FDA in Brief: FDA requires new warnings for gabapentinoids about risk of respiratory depression.
      To identify the patterns of risky prescribing and raise awareness of the potential dangers of co-prescribing, this analysis provides the first U.S. national estimates of opioid co-prescribing with benzodiazepines, nonbenzodiazepines, and gabapentinoids. The main hypothesis is that opioid–benzodiazepine co-prescribing had decreased, but other co-prescribing types had remained stable.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • National Academies of Sciences, Engineering, and Medicine
        Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use.
        The National Academies Press, Washington, DC2017
        • Vijay A
        • Ross JS
        • Shah ND
        • Jeffery MM
        • Dhruva SS
        Medicare formulary coverage and restrictions for opioid potentiators from 2013 to 2017.
        J Gen Intern Med. 2019; 34: 518-520
        • U.S. Food & Drug Administration
        FDA requires strong warnings for opioid analgesics, prescription opioid cough products, and benzodiazepine labeling related to serious risks and death from combined use.
        U.S. Food & Drug Administration. August 31, 2016;
        • Centers for Medicare and Medicaid Services
        Reduce risk of opioid overdose deaths by avoiding and reducing co-prescribing benzodiazepines.
        Centers for Medicare and Medicaid Services, Baltimore, MDPublished July 1, 2019
        • Zhang VS
        • Olfson M
        • King M
        Opioid and benzodiazepine coprescribing in the United States before and after U.S. Food and Drug Administration boxed warning.
        JAMA Psychiatry. 2019; 76: 1208-1210
        • U.S. Food and Drug Administration
        FDA in Brief: FDA requires new warnings for gabapentinoids about risk of respiratory depression.
        U.S. Food & Drug Administration, Silver Spring, MDPublished December 19, 2019
      1. National Health and Nutrition Examination Survey: NHANES 2013–2014. Centers for Disease Control and Prevention, National Center for Health Statistics.https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?BeginYear=2013. Updated August 4, 2020. Accessed November 27, 2019.

        • Hwang CS
        • Kang EM
        • Kornegay CJ
        • Staffa JA
        • Jones CM
        • McAninch JK
        Trends in the concomitant prescribing of opioids and benzodiazepines, 2002-2014.
        Am J Prev Med. 2016; 51: 151-160
        • Rhee TG.
        Coprescribing of benzodiazepines and opioids in older adults: rates, correlates, and national trends.
        J Gerontol A Biol Sci Med Sci. 2019; 74: 1910-1915
        • Pauly NJ
        • Delcher C
        • Slavova S
        • Lindahl E
        • Talbert J
        • Freeman PR
        Trends in gabapentin prescribing in a commercially insured U.S. adult population, 2009-2016.
        J Manag Care Spec Pharm. 2020; 26: 246-252