Dispensations of benzodiazepines, z-hypnotics, and gabapentinoids to patients receiving opioid agonist therapy; a prospective cohort study in Norway from 2013 to 2017

Vold, Jørn Henrik; Aas, Christer; Chalabianloo, Fatemeh; Kloster, Pia Synnøve; Johansson, Kjell Arne

doi:10.1186/s12913-020-05195-5

Cited by 11 publications

(9 citation statements)

References 23 publications

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“…All gabapentinoids 503 (8) 463 (18) 509 (9) 497 (19) 582 (10) 507 (19) Pregabalin 348 (6) 330 (13) 359 (6) 331 (12) 413 7317 (12) Gabapentin 192 (3) 164 (6) 183 3203 (8) 207 4213 (8) Strong non-OAT opioids All strong non-OAT opioids 309 (5) 280 (11) 314 (6) 275 (10) 353 (6) 262 (10) Methadone tablets or injections* Weak non-OAT opioids All weak non-OAT opioids 768 (13) 169 (6) 675 (12) 150 (6) 674 (12) 137 (5) Codeine 562 (9) 125 (5) 500 (9) 107 4470 (8) 98 ( Open access documented abstinence from potentially addictive drugs at least 3 months prior to the initiation of CAS in OAT patients when indicated. 41 This may partly explain a lower dispensing rate of CAS in Norway compared with Swedish OAT patients.…”

Section: Gabapentinoidsmentioning

confidence: 99%

“…Several studies indicate that around 50% of those patients who receive opioid agonist therapy (OAT) are dispensed benzodiazepines (e.g., diazepam and oxazepam), z-hypnotics (zolpidem and zopiclone), gabapentinoids (pregabalin and gabapentin), non-OAT opioids (e.g., morphine and oxycodone) or centrally acting stimulants (CAS) (e.g., methylphenidate and lisdexamphetamine) yearly [1][2][3][4][5] , notwithstanding the use of any potentially addictive illicit drugs. 1 6 7 Prescribing potentially addictive drugs to patients on OAT is controversial and comes with pros and cons.…”

Section: Introductionmentioning

confidence: 99%

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Potentially addictive drugs dispensing to patients receiving opioid agonist therapy: a register-based prospective cohort study in Norway and Sweden from 2015 to 2017

et al. 2020

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ObjectivesTo compare the use of benzodiazepines, z-hypnotics, gabapentinoids, opioids and centrally acting stimulants (CAS) among patients who had received opioid agonist therapy (OAT) in Norway and Sweden during the period 2015 - 2017.DesignA register-based prospective cohort study using information about dispensed drugs from the Norwegian Prescription Database and Swedish Prescribed Drug Register.SettingPatients who were dispensed OAT opioids from pharmacies.ParticipantsA total of 7176 Norwegian and 3591 Swedish patients on OAT were included.Outcome measuresThe number and frequency of potentially addictive drugs dispensed were calculated for the two countries. The mean daily doses of dispensed benzodiazepines and z-hypnotics were summarised by calculating benzodiazepines in diazepam equivalents and z-hypnotics in zopiclone equivalents.ResultsIn 2017, 46% of patients in Norway, and 15% in Sweden, were dispensed a benzodiazepine. Moreover, 14% in Norway and 26% in Sweden received z-hypnotics. Gabapentinoids were dispensed to 10% of patients in Norway and 19% of patients in Sweden. In Norway, 6% and 12% of the patients received strong and weak non-OAT opioids, respectively, whereas in Sweden 10% were dispensed strong non-OAT opioids and 5% weak non-OAT opioids . CAS were dispensed to 4% in Norway and 18% in Sweden. The mean daily doses of benzodiazepines were 16 and 17 mg diazepam equivalents in Norway and Sweden, respectively. For z-hypnotics, the mean daily dose was 8 mg zopiclone equivalents in both countries. ‘Benzodiazepines and z-hypnotics’ was the most dispensed drug combination in 2017. Similar results were found in 2015 and 2016.ConclusionsNearly half of those patients who were dispensed an OAT opioid in Norway and Sweden were dispensed potentially addictive drugs. The differences identified between Norway and Sweden might be related to differences in eligibility guidelines and restrictions with respect to OAT.

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Section: Gabapentinoidsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Potentially addictive drugs dispensing to patients receiving opioid agonist therapy: a register-based prospective cohort study in Norway and Sweden from 2015 to 2017

et al. 2020

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“…Given the benzodiazepine-related harms in opioid-dependent patients, researchers have called for increased focus on the treatment of psychiatric co-occurring disorders in this condition to decrease the reasons for self-medication use of benzodiazepines [ 44 ]. Finally, dispensation of sedative-hypnotics, or benzodiazepines to patients in OMT are common and have pros and cons [ 53 ]. It has recently been shown that a substantial minority of OMT patients in Sweden were dispensed benzodiazepines (15%) and z-hypnotics (26%) [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Substance Use, Hospitalizations, and Co-Occurring Disorders among Patients Transferred from a Needle Exchange Program to Opioid Maintenance Treatment

Bråbäck

Brantefors

Franck

et al. 2022

IJERPH

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Opioid use disorders (OUD) is a relapsing condition with high mortality. Opioid maintenance treatment (OMT) reduces heroin use, and overall morbidity and mortality. The prevalence of psychiatric and substance use disorders, potential baseline predictors for psychiatric hospitalization, and psychiatric diagnoses at follow-up were investigated and may give hints about possible preventative strategies. The medical records for 71 patients were reviewed 36 months following referral to OMT from a needle exchange program (NEP). Their psychiatric diagnoses and hospitalizations were identified. Their baseline characteristics were assessed for potential differences between hospitalized versus non-hospitalized patients and between patients with and without psychiatric diagnoses in a longitudinal observational study without controls. A regression analysis was performed to identify predictors for hospitalization when controlling for OMT status. Sixty-five percent of the patients were hospitalized at least once with a psychiatric diagnosis. Substance-related reasons were prevalent, and detoxification occurred among 59% of patients, with sedative- hypnotics (benzodiazepines, zopiclone, zolpidem, and pregabalin) being the substance used by 52% of patients. Baseline use of these drugs and/or buprenorphine predicted for hospitalization when controlling for OMT status. During the follow-up period, 72% of patients met the criteria for a psychiatric diagnosis other than OUD. The prevalence of non-substance use disorders overlapping with SUD was 41%, and that overlapping with anxiety disorder was 27% of all participants. Increased attention to psychiatric co-occurring disorders in the treatment of OUD is required and the importance of addressing sedative-hypnotics use when initiating OMT is highlighted.

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“…Older SUD patients usually have more substance-related physical and mental comorbidities than younger patients, placing a higher responsibility on existing health care services. Previous observational studies have shown that receiving health services and being older were associated with more legal prescriptions for addictive medications compared with being younger, potentially making illegal substance use less likely [ 35 – 37 ]. This might explain the lower illegal substance use among older SUD patients.…”

Section: Discussionmentioning

confidence: 99%

Changes in substance use during outpatient treatment for substance use disorders: a prospective Norwegian cohort study from 2016 to 2020

Vold

Chalabianloo

Christer

et al. 2021

Subst Abuse Treat Prev Policy

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Background Continuous use of amphetamines, alcohol, benzodiazepines, cannabis, cocaine, or opioids contributes to health impairments, increased morbidity, and overdose deaths among patients with substance use disorders (SUDs). This study evaluates the impact of inpatient detoxification, injecting substance use, age, and gender on substance use over time among patients undergoing outpatient SUD treatment. Methods We used data from a cohort of SUD patients in Norway obtained from health assessments of self-reported substance use and sociodemographic and clinical factors. A total of 881 substance use measurements, including substances and frequency of use, were assessed for 708 SUD patients in 2016–2020. Of those, 171 patients provided two or more substance use measurements. The total substance use was calculated, creating a substance use severity index (SUSI), ranging from zero (no use) to one (daily use of all substances). We defined baseline as the first substance use measurement when the measurements were listed chronologically. Time was defined as years from baseline. We used a linear mixed model to analyze the SUSI at baseline and over time, and its associations with inpatient detoxification, injecting substance use, gender, and age, presented with coefficients and 95% confidence intervals (CI). Results No longitudinal changes in the SUSI were found compared with baseline (change in SUSI (cSUSI): 0.04, 95% CI: − 0.05;0.13, p = 0.397). Likewise, “inpatient detoxification” was not associated with changes in the SUSI compared with “no inpatient detoxification” (cSUSI: 0.00, 95% CI: − 0.04;0.04, p = 0.952). However, injecting substances were associated with a higher SUSI than not injecting substances at baseline (difference in SUSI: 0.19, 95% CI: 0.16;0.21, p = < 0.001), and starting to inject substances was associated with increasing SUSI over time compared with not starting to inject substances (cSUSI: 0.11, 95% CI: 0.07;0.15, p = < 0.001). Gender was not significantly associated with changes in the SUSI (cSUSI: − 0.04, 95% CI: − 0.07;0.00, p = 0.052), while patients over 60 years of age had a lower SUSI than those under the age of 30 at baseline (difference in SUSI: − 0.08, 95% CI: − 0.14;− 0.01, p = 0.018), with no change over time (cSUSI: − 0.05, 95% CI: − 0.16;0.05, p = 0.297). Conclusion The present study demonstrates that inpatient detoxification was not associated with substance use changes over time for patients undergoing outpatient SUD treatment. Otherwise, injecting substance use was a particular risk factor for a high level of substance use. Future research needs to evaluate the impact of other treatment approaches on substance use, ideally in randomized controlled trials.

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Dispensations of benzodiazepines, z-hypnotics, and gabapentinoids to patients receiving opioid agonist therapy; a prospective cohort study in Norway from 2013 to 2017

Cited by 11 publications

References 23 publications

Potentially addictive drugs dispensing to patients receiving opioid agonist therapy: a register-based prospective cohort study in Norway and Sweden from 2015 to 2017

Potentially addictive drugs dispensing to patients receiving opioid agonist therapy: a register-based prospective cohort study in Norway and Sweden from 2015 to 2017

Substance Use, Hospitalizations, and Co-Occurring Disorders among Patients Transferred from a Needle Exchange Program to Opioid Maintenance Treatment

Changes in substance use during outpatient treatment for substance use disorders: a prospective Norwegian cohort study from 2016 to 2020

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