Opioid analgesic and benzodiazepine prescribing among Medicaid-enrollees with opioid use disorders: The influence of provider communities

Abstract

Background Opioid analgesic and benzodiazepine use in individuals with opioid use disorders (OUDs) can increase the risk for medical consequences and relapse. Little is known about rates of use of these medications or prescribing patterns among communities of prescribers. Aims To examine rates of prescribing to Medicaid-enrollees in the calendar year after an OUD diagnosis, and to examine individual, county, and provider community factors associated with such prescribing. Methods We used 2008 Medicaid claims data from 12 states to identify enrollees diagnosed with OUDs, and 2009 claims data to identify rates of prescribing of each drug. We used social network analysis to identify provider communities and multivariate regression analyses to identify patient, county, and provider community level factors associated with prescribing these drugs. We also examined variation in rates of prescribing across provider communities. Results Among Medicaid-enrollees identified with an OUD, 45% filled a prescription for an opioid analgesic, 37% for a benzodiazepine, and 21% for both in the year following their diagnosis. Females, older individuals, individuals with pain syndromes, and individuals residing in counties with higher rates of poverty were more likely to fill prescriptions. Prescribing rates varied substantially across provider communities, with rates in the highest quartile of prescribing communities over 2.5 times the rates in the lowest prescribing communities. Discussion Prescribing opioid analgesics and benzodiazepines to individuals diagnosed with OUDs may increase risk of relapse and overdose. Interventions should be considered that target provider communities with the highest rates of prescribing and individuals at highest risk.

County and Physician Variation in Benzodiazepine Prescribing to Medicare Beneficiaries by Primary Care Physicians in the USA

“…Our findings are consistent with a recent analysis of opioid and BZD prescribing to Medicaid beneficiaries with opioid use disorders, where prescribing rates varied significantly by provider and were higher in high-poverty counties. 36 Some of the socioeconomic characteristics associated with BZD prescribing intensity have also been proposed as determinants in the opioid crisis 37 ; it is unsurprising the same PCPs might be high-intensity prescribers of both.…”

Association between process measures and mortality in individuals with opioid use disorders

“…Prior studies have suggested that substantial numbers of individuals treated for OUDs may be prescribed opioids and benzodiazepines (Stein et al, 2016). There are a number of mechanisms whereby prescribing either benzodiazepines or opioids to individuals with OUDs may lead to increased mortality (Charlson et al, 2009; Weisberg et al, 2015).…”

Prevalence and correlates of benzodiazepine use and misuse among young adults who use prescription opioids non-medically

“…For those who misuse opioids, benzodiazepine use has been associated with being white (Cropsey et al, 2015; Tucker et al, 2016); being female (Cropsey et al, 2015; Stein et al, 2017b); older age (Stein et al, 2017b); and incarceration history (Tucker et al, 2016). Non-medical benzodiazepine use has been associated with screening positive for anxiety, depression, and other mental health concerns in this population (Chen et al, 2011; Lavie et al, 2009).…”