Efforts to stop coprescribing of opioids, benzodiazepines helped, but problem ongoing

Concurrent prescriptions of opioids and benzodiazepines declined significantly or remained unchanged since 2016, particularly among young adults and patients with alcohol use disorder (AUD), according to recent research.

In one study, CDC researchers used a national database containing prescription records from a sample of about 49,900 outlets that dispense nearly 92% of retail pharmacy prescriptions in the U.S. to examine trends in concurrent opioid and benzodiazepine prescriptions from 2016 to 2019. The results were published as a research report by Annals of Internal Medicine on June 7.

The numbers of patients with opioid, benzodiazepine, or concurrent prescriptions all declined from 2016 to 2019, with concurrent prescriptions dropping the most (41%). The study authors noted that the period examined was after federal efforts to address opioid and benzodiazepine coprescribing, including adding a boxed warning to prescription labels in 2016 and a federal guideline for prescribing opioids for chronic pain.

They highlighted the need for continued public health and clinical actions, including greater adherence to evidence-based prescribing guidelines, more patient education, and alternative pain-management options, adding that there is also a need for evidence-based protocols to safely deprescribe opioids and/or benzodiazepines.

A second study estimated opioid/benzodiazepine prescribing among individuals with AUD in New York State. A total of 148,328 patients with a primary diagnosis of AUD and a first admission to a state addiction treatment program from 2005 to 2018 were included. This period covered the time frame when the Internet System for Tracking Over-Prescribing (I-STOP), a prescription monitoring program, was implemented in August 2013. Results were published by the Journal of General Internal Medicine on June 1.

Opioid prescribing rates decreased from before to after I-STOP, from 25.1% (95% CI, 24.9% to 25.3%) to 21.3% (95% CI, 21.2% to 21.4%) (P<0.001), while prescribing rates for benzodiazepines (9.96% to 9.92%; P=0.631) and opioids/benzodiazepines (3.01% to 3.05%; P=0.403) remained unchanged. After I-STOP began, there was a significant decreasing trend in prescribing of opioids (change, −1.85% per year; P<0.0001), benzodiazepines (−0.208% per year; P=0.0184), and opioids/benzodiazepines (−0.267% per year; P<0.0001). Opioid, benzodiazepine, and coprescription rates were higher in women, White non-Hispanics, and patients in rural regions.

The study authors concluded, “Overall, opioid and benzodiazepine prescribing among this higher-risk group still occurred at high rates, representing an opportunity to develop innovative approaches to improve patient care and quality in those with alcohol and polysubstance use. Further research is needed to identify patients at greatest risk and continue to develop and integrate evidence-based interventions into treatment platforms.”