Opioid Dose and Benzodiazepine Use Among Commercially Insured Individuals on Chronic Opioid Therapy

Abstract

Objective To examine morphine milligram equivalent (MME) trends, use of concurrent opioids and benzodiazepines, and opioid-related emergency department (ED) visits or hospitalizations in a national cohort of patients on chronic opioid therapy. Design Retrospective cohort analysis of prospectively collected data from the Truven Health MarketScan Commercial Claims and Encounters database from 2009 to 2015. This includes individuals in both the Commercial Claims and Medicare Supplemental databases of MarketScan. Methods MME comparisons of 1) patients on chronic opioids with and without opioid-related ED visits or hospitalizations, 2) patients on concurrent opioids and benzodiazepines with and without opioid-related ED visits or hospitalizations, and 3) patients on chronic opioids compared with those on concurrent opioid and benzodiazepine using the Student t test. Results MME decreased from 194 mg in 2009 to 119 mg in 2015 among patients on chronic opioids. Patients on opioids and benzodiazepines had higher doses than those on opioids alone for all years (P < 0.001). Those with an opioid-related ED visit or hospitalization had a higher average MME than those without, for all years except 2009 (P < 0.05). Patients on chronic opioids or on concurrent benzodiazepine with an MME >50 had a twofold increased risk of having an opioid-related ED visit or hospitalization compared with those with an MME <50, for all years. Conclusions Although the average MME decreased over time, patients on combination opioid and benzodiazepine and those with opioid-related ED visits and hospitalizations had significantly higher doses.

The Status and Prescription Patterns of Opioid Utilization in a Large Comprehensive Teaching Hospital in China According to the Anatomical Therapeutic Chemical Classification/Defined Daily Dose Methodology

“…Given that there is no international standard for measuring the level of hospital opioid consumption, comparisons were made between our collected data and existing foreign published studies on drug utilization and opioid consumption evaluations in hospital settings based on the ATC/DDD system. We confirmed the hypothesis of our study, that is, opioid consumption at this hospital was relatively low compared with the consumption rates reported in other studies, which included two hospitals and four databases from Europe, East Asia, and North America (12)(13)(14)(15)(16)(17). One study using the same measurement unit (DDD/100 bed-days), carried out in a hospital in Madrid, Spain, revealed that opioid consumption had a remarkable increasing tendency, from 22.3 DDD/100 bed-days in 2011 to 26.5 DDD/100 beddays in 2015 (16).…”