Benzodiazepine Use among Chronic Pain Patients Prescribed Opioids: Associations with Pain, Physical and Mental Health, and Health Service Utilization

Nielsen, Suzanne; Lintzeris, Nicholas; Bruno, Raimondo; Campbell, Gabrielle; Larance, Briony; Hall, Wayne; Hoban, Bianca; Cohen, Milton; Degenhardt, Louisa

doi:10.1111/pme.12594

Cited by 107 publications

(104 citation statements)

References 36 publications

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“…It is well‐known that opioid users, especially long‐term high dose opioid users, have increased risks for co‐medication with BZDs or Z‐hypnotics compared with non‐opioid users . Likewise, in our study, high‐dose opioid users were also high‐dose users of sedative.…”

Section: Discussionsupporting

confidence: 62%

Tramadol use in Norway: A register‐based population study

Birke

Ekholm

Sjögren

et al. 2018

Pharmacoepidemiology and Drug

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Section: Discussionsupporting

confidence: 62%

Tramadol use in Norway: A register‐based population study

Birke

Ekholm

Sjögren

et al. 2018

Pharmacoepidemiology and Drug

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“…10,11,28,29 and we found that hypnotics and skeletal muscle relaxants were also associated with longer opioid durations and co-prescribing these drugs have also been shown to be associated with opioid use. 6,15,25 Our analyses show that the likelihood of opioid discontinuation is slowly increasing with time (HR=1.02 in 2007 vs HR=1.11 in 2014) which suggests that prescribers may be becoming more aware of the harms of long-term opioid use.…”

Section: Discussionmentioning

confidence: 76%

Factors Influencing Long-Term Opioid Use Among Opioid Naive Patients: An Examination of Initial Prescription Characteristics and Pain Etiologies

Shah

Hayes

Martin

2017

The Journal of Pain

213

180

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The relationships of characteristics of the initial opioid prescription and pain etiology with the probability of opioid discontinuation were explored in this retrospective cohort study using health insurance claims data from a nationally representative database of commercially insured patients in the U.S. We identified 1,353,902 persons aged ≥14 with no history of cancer or substance abuse, with new opioid use episodes and categorized them into 11 mutually exclusive pain etiologies. Cox Proportional Hazards models were estimated to identify factors associated with time to opioid discontinuation. After accounting for losses to follow-up, the probability of continued opioid use at one year was 5.3% across all subjects. Patients with chronic pain had the highest probability for continued opioid use followed by patients with inpatient admissions. Patients prescribed doses above 90 morphine milligram equivalents (HR=0.91, CI: 0.91–0.92); initiated on tramadol (HR=0.90, CI: 0.89–0.91) or long-acting opioids (HR=0.78, CI: 0.75–0.80); were less likely to discontinue opioids. Increasing days’ supply of the first prescription was consistently associated with a lower likelihood of opioid discontinuation (HRs, CIs: 3–4 days’ supply = 0.70, 0.70–0.71; 5–7 days’ supply = 0.48, 0.47–0.48; 8–10 days’ supply = 0.37, 0.37–0.38; 11–14 days’ supply = 0.32, 0.31–0.33; 15–21 days’ supply = 0.29, 0.28– 0.29; ≥22 days supplied = 0.20, 0.19–0.20). The direction of this relationship was consistent across all pain etiologies. Clinicians should initiate patients with the lowest supply of opioids to mitigate unintentional long term opioid use.

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“…More specifically, the study used data from 16 years of the National Health and Nutritional Examination Survey (NHANES) for years 1999 to 2014 to examine trends in use of prescription opioids as well as long‐term use of opioids. In addition, associations of long‐term use with indicators of elevated risk of adverse effects from opioid treatment were examined, including presence of painful conditions, severe medical conditions, concomitant use of benzodiazepines, and history of heroin and alcohol misuse …”

Section: Introductionmentioning

confidence: 99%