Concomitant inpatient prescribing of strong opioids with sedatives: Associations with comorbid conditions

Abstract

Co‐prescribing of opioids and sedatives is a known risk factor for opioid‐induced ventilatory impairment (OIVI). Prevalence data for sedative and opioid co‐prescription in inpatients in Australia are unknown. Our objective was to determine the prevalence of inpatient sedative and opioid co‐prescribing and to identify factors associated with co‐prescription. We conducted a retrospective cross‐sectional study from July 2017 to October 2017 across four South Australian hospitals utilizing a centralized electronic health record. Multivariate analysis was used to identify characteristics predictive of co‐prescribing of a strong opioid (fentanyl, hydromorphone, morphine, and oxycodone) and sedative medications (benzodiazepines, antiepileptics, antipsychotics, and tricyclic antidepressants). Of the 6170 inpatients, 2795 (45.3%) were prescribed a strong opioid and of those, 1889 (30.6% of all inpatients) were co‐prescribed a sedative. Of those prescribed a strong opioid, five (0.18%) developed OIVI. Patients prescribed a strong opioid had a 27–77% increased likelihood of being prescribed a sedative. Factors predictive of sedative co‐prescribing included the presence of disease of the central nervous system adjusted OR (aOR) 8.66 [95% CI 5.83–12.9] and respiratory disease aOR 1.42 [95% CI 1.17–1.72]. Nearly, one third of all hospital inpatients were co‐prescribed a strong opioid and a sedative medication. Patients with comorbidities resulting in increased risk of respiratory depression/OIVI were more likely to have sedative co‐prescription. Clinicians should be aware of the effects of high‐risk medications and ensure that systems and monitoring are in place that help mitigate adverse outcomes.

Benzodiazepines and Related Drugs in Orthopaedics

“…They can also cause a modest reduction in arterial blood pressure and an increase in heart rate as a result of a decrease in systemic vascular resistance 47 . In the inpatient population, a study found that opioid use in addition to a benzodiazepine or other sedative medications, such as antiepileptics, antipsychotics, or tricyclic antidepressants, resulted in an increased risk of respiratory depression 48 . Another study found that benzodiazepine use with or without concomitant opioid use can, therefore, increase the risk of hospitalization in patients with chronic lung disease 49 .…”