Sedative-hypnotic Co-prescribing with Opioids in a Large Network of Community Health Centers

Abstract

Objective: When prescribed with opioids, sedative-hypnotics substantially increase the risk of overdose. The objective of this paper was to describe characteristics and trends in opioid sedative-hypnotic co-prescribing in a network of safety-net clinics serving low-income, publicly insured, and uninsured individuals. Methods: This retrospective longitudinal analysis of prescription orders examined opioid sedative-hypnotic co-prescribing rates between 2009 and 2018 in the OCHIN network of safety-net community health centers. Sedative-hypnotics included benzodiazepine and non-benzodiazepine sedatives (eg, zolpidem). Co-prescribing patterns were assessed overall and across patient demographic and co-morbidity characteristics. Results: From 2009 to 2018, 240 587 patients had ≥1 opioid prescriptions. Most were White (65%), female (59%), and had Medicaid insurance (43%). One in 4 were chronic opioid users (25%). During this period, 55 332 (23%) were co-prescribed a sedative-hypnotic. The prevalence of co-prescribing was highest for females (26% vs 19% for males), non-Hispanic Whites (28% vs 13% for Hispanic to 20% for unknown), those over 44 years of age (25% vs 20% for <44 years), Medicare insurance (30% vs 21% for uninsured to 22% for other/unknown), and among those on chronic opioid therapy (40%). Co-prescribing peaked in 2010 (32%) and declined steadily through 2018 (20%). Trends were similar across demographic subgroups. Co-prescribed sedative-hypnotics remained elevated for those with chronic opioid use (27%), non-Hispanic Whites (24%), females (23%), and those with Medicare (23%) or commercial insurance (22%). Conclusions: Co-prescribed sedative-hypnotic use has declined steadily since 2010 across all demographic subgroups in the OCHIN population. Concurrent use remains elevated in several population subgroups.

Characterising incident opioid use among incident users of prescription sedative hypnotics: A national cohort study

“… 36 However, our findings of higher likelihood of patients with substance use disorder being coprescribed sedatives and opioids align with the Hartung et al study. 36 However, it is noted that this is not an all-encompassing summary of all the conditions that could be associated with coprescribing. For example, this study did not account for conditions such as insomnia, pain and cancer which have all been mentioned in previous studies as potential reasons for prescribing both a sedative and opioid.…”

“…This differs from the results of another recent study which showed an increased rate of coprescribing in patients with comorbidities such as anxiety, depression Open access and severe mental illness. 36 However, our findings of higher likelihood of patients with substance use disorder being coprescribed sedatives and opioids align with the Hartung et al study. 36 However, it is noted that this is not an all-encompassing summary of all the conditions that could be associated with coprescribing.…”

“…This study found that one in five patients who received sedatives also received opioid prescriptions which aligns with prior studies. 35 36 However, these prior studies examined either coprescriptions patterns among incident opioid patients who received opioids as index drug 36 or focused on benzodiazepines. 35 Our study cohort included patients with three main types of sedatives (benzodiazepines, barbiturates and z-drugs).…”

“…Furthermore, our study found that coprescription with opioids showed a gradual decline after 2008 which aligns with findings from previous similar studies. 36 44 Since this study examined individuals who had not received opioids in the year prior to the index date, we were able to provide insight on patients who were recently coprescribed opioids and sedatives as compared with individuals who may have been on the combination long term.…”

“…About 86% of 12 000 benzodiazepine overdose-related deaths in 2020 involved coprescription of opioids. 36 Moreover, there are sedatives, other than benzodiazepines, that are frequently used with opioids and present similar health risks including overdose-related risks. 34 However, there are no clear recommendations for other sedatives.…”