PCR063: Sedative-hypnotic Co-prescribing with Opioids in a Large Network of Community Health Centers

Daniel Hartung, MPH, PharmD; Jennifer Lucas, PhD; Robert Voss, MS; Jean O'Malley, MPH, PStat; Nathalie Huguet, PhD; Steffani Bailey, PhD; Maria Ukhanova, MD, PhD; Irina Chamine, PhD; John Muench, MD, MPH

Abstract

Context: Although opioid prescribing has declined nationally since 2011, sedative hypnotic use remains elevated. It is unclear if rates of co-prescribed sedative-hypnotics have declined in parallel with opioid use. Objective: 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. Study Design: Retrospective longitudinal analysis of prescription orders between 2009 and 2018. Setting or Dataset: Electronic health records from OCHIN, a large network of community health centers in the US. Population Studied: OCHIN safety-net clinics serve low-income, uninsured, and under-insured populations. The study population were individuals with ≥1 OCHIN primary care visits in any calendar year and prescribed an opioid analgesic in any calendar half-year. Outcomes Measures: Co-prescribing defined as an opioid and sedative-hypnotic prescription in the same six-month calendar period. Sedative-hypnotics included benzodiazepine and non-benzodiazepine sedatives (e.g. zolpidem). Co-prescribing patterns were assessed overall and across patient demographic and co-morbidity characteristics. Trends in co-prescribing were also evaluated by patient characteristics. Results: From 2009 to 2018, 257,848 OCHIN patients had at ≥1 opioid prescriptions. The study population was predominately White (63%), female (59%), and had Medicaid insurance (43%). One in five were chronic opioid users (21%). During this period, 56,877 (22%) had a co-prescribed sedative-hypnotic. Prevalence of co-prescribing was highest for females (25% vs 18% for males), Whites (27% vs 12% for Hispanic to 19% for unknown), those over 44 years of age (25% vs 18% for < 44 years) Medicare insurance (30% vs 11% to 19%), and among those on chronic opioid therapy (43%). The most commonly co-prescribed sedative-hypnotics were lorazepam (36%), zolpidem (28%), clonazepam (23%), diazepam (20%), and alprazolam (20%). Co-prescribing peaked in 2010 (29%), and declined steadily through 2018 (16%). Trends were similar across demographic subgroups. Co-prescribed sedative-hypnotics remained over 20% for White individuals and those with Medicare. Conclusions: In concert with opioid use, co-prescribed sedative-hypnotic has declined steadily since 2011 across all demographic subgroups. However, concurrent use remains elevated in White individuals and those with Medicare.
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Jack Westfall
jwestfall@aafp.org 11/20/2021

very important topic. hope to see more come from this study. thanks.

Diane Harper
harperdi@med.umich.edu 11/21/2021

are there action items from this work? where and how do you see it impacting the clinic office? great work!

Gillian Bartlett
gillian.bartlett@health.missouri.edu 11/23/2021

My PhD work was on patterns of benzodiazepine prescribing over 5-years. What I found in my work is that when benzo prescribing goes down, other meds go up. Did you look at things other than opioids? Such as other psychotropics? Great work.

Andy Pasternak
avpiv711@sbcglobal.net 11/28/2021

Such an important topic as this is such a bad combo of meds

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