Concomitant Use of Opioids and Benzodiazepines in the Outpatient Setting

Abstract

III.

Concurrent Use of Opioids with Other Central Nervous System-Active Medications Among Older Adults

“…[4][5][6][7][8][9][10][11][12] Yet, despite the contraindications and warnings, concurrent use of opioids with other CNS-active medications, especially benzodiazepines, remains common across age groups and within various patient settings. 8,9,13,14 To date, concurrent use has no consistent definition in the scientific literature and has been variously defined as an overlap of 1 day, [15][16][17] 30 days, 18 or 90 days 7 when pharmaceutical claims were available or, more commonly, as during the same time period on surveys such as the National Ambulatory Medical Care Survey. 8,9,13,14,19 Because the medications are widely utilized across all age groups, study samples are often population based including adults aged ‡18 years with fewer studies focused on older adults aged ‡65 years.…”

“…4,8,11,[19][20][21] Furthermore, there is no consistent list of other CNS-active medications used with opioids. Concurrent use studies have been unilateral, such as those describing opioids with benzodiazepines [7][8][9][10]14,17,18,22 or opioids with gabapentinoids, 12,23,24 or have included various combinations of opioids with benzodiazepines, nonbenzodiazepine hypnotics, antipsychotics, muscle relaxants, and/or gabapentinoids. [4][5][6]13,15,16,19 Consequently, the prevalence of concurrent use varies in the scientific literature depending on the age range of study samples, definitions of use, number of medications included, and the time frame of the study.…”

“…[4][5][6]13,15,16,19 Consequently, the prevalence of concurrent use varies in the scientific literature depending on the age range of study samples, definitions of use, number of medications included, and the time frame of the study. Concurrent use has been reported from about 13% to 49% for opioids combined with a single CNSactive medication, [6][7][8]10,13,[16][17][18] such as benzodiazepines, non-benzodiazepine hypnotics, or antipsychotics, and from 25% to 55% for opioids combined with >1 CNS medication. 5,6,15,19 Such concomitant pharmaceutical solutions are frequently offered as first-line treatment options whether patients present in a provider's office or in the emergency room (ER) for the treatment of chronic pain complicated with anxiety, insomnia, or other mental health issues.…”

“…5,6,15,19 Such concomitant pharmaceutical solutions are frequently offered as first-line treatment options whether patients present in a provider's office or in the emergency room (ER) for the treatment of chronic pain complicated with anxiety, insomnia, or other mental health issues. 5,6,8,11,14,18,19,22,25 The providers prescribing concurrent opioids and other CNS-active medications have been characterized primarily as primary care providers (PCPs) who manage the regular care of their patients. 5,6,8,14,18,19 However, the Veteran's Administration (VA), with a designed specialist referral system and computerized drug monitoring, has reported opioids to be more often prescribed by PCPs, with benzodiazepines and other mental health medications more often prescribed by mental health providers.…”

“…5,6,8,11,14,18,19,22,25 The providers prescribing concurrent opioids and other CNS-active medications have been characterized primarily as primary care providers (PCPs) who manage the regular care of their patients. 5,6,8,14,18,19 However, the Veteran's Administration (VA), with a designed specialist referral system and computerized drug monitoring, has reported opioids to be more often prescribed by PCPs, with benzodiazepines and other mental health medications more often prescribed by mental health providers. 5,15,25 As a result, more than 60% of concurrent use prescriptions were ordered by different providers.…”