Trends in prescribing pattern of opioid and benzodiazepine substitutes among Medicare part D beneficiaries from 2013 to 2018: a retrospective study

Abstract

ObjectiveOpioid and benzodiazepine co-prescribing is associated with a substantial increase in opioid overdose deaths. In this study, we examine the prescribing trends of substitutes of opioids and benzodiazepines alone or in combination, compared with opioids and benzodiazepines.DesignRetrospective cohort study.SettingData were collected using a 20% national sample of Medicare beneficiaries from 2013 to 2018.Participants4.1–4.3 million enrollees each year from 2013 to 2018.InterventionNone.Primary outcomeWe employ a generalised linear mixed models to calculate ORs for opioid use, benzodiazepine or Z-drug (benzos/Z-drugs) use, opioid/benzos/Z-drugs 30-day use, gabapentinoid use and (selective serotonin reuptake inhibitors (SSRI) and serotonin norepinephrine reuptake inhibitors (SNRIs)) use, adjusted for the repeated measure of patient. We then created two models to calculate the ORs for each year and comparing to 2013.ResultsOpioid and benzos/Z-drugs use decreased by 2018 (aOR 0.626; 95% CI 0.622 to 0.630) comparing to 2013. We demonstrate a 36.3% and 9.9% increase rate of gabapentinoid and SSRI/SNRI use, respectively. Furthermore, combined gabapentinoid and SSRI/SNRI use increased in 2018 (aOR 1.422; 95% CI 1.412 to 1.431).ConclusionLittle is known about the prescribing pattern and trend of opioid and benzodiazepine alternatives as analgesics. There is a modest shift from prescribing opioid and benzos/Z-drugs (alone or in combination) towards prescribing non-opioid analgesics—gabapentinoids with and without non-benzos/Z-drugs that are indicated for anxiety. It is unclear if this trend towards opioid/benzos/Z-drugs alternatives is associated with fewer drug overdose death, better control of pain and comorbid anxiety, and improved quality of life.

Co-prescribing of Central Nervous System–Active Medications for COPD Patients: Impact on Emergency Room Visits and Hospitalization

“…15,16 Gorfinkel et al 17 reported that following CDC recommendations in 2016, there was a decrease in prescription of opioids and an increase in prescription of nonopioids, including gabapentinoids (GABA) and antidepressants. Esechie et al 18 reported a similar pattern among Medicare beneficiaries. Drug Enforcement Agency and state lawmakers in the United States have also implemented policies limiting the use of opioids.…”

Trends in the Use of Opioids vs Nonpharmacologic Treatments in Adults With Pain, 2011-2019

“…Pharmacologic opioid substitutes were not within the scope of this study because prior research identified trends in the use of gabapentinoids, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors for pain treatment. 51 Use of gabapentinoids increased in prevalence over the study period but remained uncommon (<10%). Therefore, it is less likely that these medications were associated with the increases in nonpharmacologic treatments between 2016 and 2019.…”

“…Similar to 2013 to 2018 trends among Medicare enrollees, we found increasing trends in the use of opioid substitutes, such as gabapentinoids, between 2011 and 2019. 51 This transition coincides with a growing awareness of an increased risk for falls and other complications when central nervous system-acting medications are concomitantly prescribed. 10 In addition, a limited referral network may explain the limited use of nonpharmacologic treatments.…”

Impact of persistent pain on function, cognition, and well‐being of older adults

“…A study of Part D prescriptions in 2018 showed that 30.4% of Medicare beneficiaries still received an opioid prescription that year. 29 While evidence for effective nonpharmacologic therapies are emerging, (e.g., cognitive behavioral therapy and exercise), few studies include in older adults with complex medical needs. 30 In our previous work, 31 we found that many older adults lack access to effective nonpharmacologic treatments and received receive little guidance from their primary care providers regarding effective pain interventions.…”

“…Despite an array of adverse effects associated with the use of opioids in older adults, 28 many clinicians still resort to their use given few accessible alternative strategies. A study of Part D prescriptions in 2018 showed that 30.4% of Medicare beneficiaries still received an opioid prescription that year 29 . While evidence for effective nonpharmacologic therapies are emerging, (e.g., cognitive behavioral therapy and exercise), few studies include in older adults with complex medical needs 30 .…”