Opioid Prescribing in the 2016 Medicare <scp>Fee‐for‐Service</scp> Population

Maciejewski, Matthew L.; Zepel, Lindsay; Hale, Sarah; Wang, Virginia; Diamantidis, Clarissa J.; Blaz, Jacquelyn W.; Olin, S. Serene; Wilson‐Frederick, Shondelle M.; James, Cara; Smith, Valerie A.

doi:10.1111/jgs.16911

Cited by 7 publications

(6 citation statements)

References 26 publications

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“…Deprescribing, the reduction of medications for which the potential harms outweigh the likelihood for benefit [ 6 ], is a solution for mitigating medication-related harms, such as falls, by aligning prescribing with goals of care and prognosis. Studies have shown that numerous older adults are prescribed opioids or BZDs in the time leading up to a serious fall [ 2 , 3 , 7 – 9 ], making these medications an obvious priority for deprescribing. Unfortunately, a number of barriers prevent prescribers’ ability to deprescribe medications in routine clinical practice in primary care, including lack of time, insufficient safety data, and having multiple prescribers [ 10 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Primary-Care Prescribers’ Perspectives on Deprescribing Opioids and Benzodiazepines in Older Adults

et al. 2022

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Purpose Opioids and benzodiazepines (BZDs) are frequently implicated as contributing to falls in older adults. Deprescribing of these medications continues to be challenging. This study evaluated primary-care prescribers’ confidence in and perceptions of deprescribing opioids and BZDs for older adults. Methods For this study, we conducted a quantitative analysis of survey data combined with an analysis of qualitative data from a focus group. A survey evaluating prescriber confidence in deprescribing opioids and BZDs was distributed to providers at 15 primary-care clinics in North Carolina between March-December 2020. Average confidence (scale 0–100) for deprescribing opioids, deprescribing BZDs, and deprescribing under impeding circumstances were reported. A virtual focus group was conducted in March 2020 to identify specific barriers and facilitators to deprescribing opioids and BZDs. Audio recordings and transcripts were analyzed using inductive coding. Results We evaluated 61 survey responses (69.3% response rate). Respondents were predominantly physicians (54.8%), but also included nurse practitioners (24.6%) and physician assistants (19.4%). Average overall confidence in deprescribing was comparable for opioids (64.5) and BZDs (65.9), but was lower for deprescribing under impeding circumstances (53.7). In the focus group, prescribers noted they met more resistance when deprescribing BZDs and that issues such as lack of time, availability of mental health resources, and patients seeing multiple prescribers were barriers to deprescribing. Conclusion Findings from quantitative and qualitative analyses identified that prescribers were moderately confident in their ability to deprescribe both opioids and BZDs in older adults, but less confident under potentially impeding circumstances. Future studies are needed to evaluate policies and interventions to overcome barriers to deprescribing opioids and BZDs in primary care. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00967-6.

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Section: Introductionmentioning

confidence: 99%

Primary-Care Prescribers’ Perspectives on Deprescribing Opioids and Benzodiazepines in Older Adults

et al. 2022

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“…Consistent with other studies, our study showed significant differences in the use and prescribing opioids and BZDs by sex, race, and geographic location. [1][2][3][4][5][6][7][8]14,15 Disparities in prescribing, are of great importance considering that historically marginalized individuals disproportionally experience worse health outcomes and suboptimal care. 11,16,17 Considering the potential for abuse and misuse, it is also critical to recognize that such disparities may also contribute to overprescribing.…”

Section: Discussionmentioning

confidence: 99%

“…Women are more likely to be prescribed and fill BZD prescriptions than men, and non-White patients are less likely to be prescribed and fill BZDs compared to White patients. [1][2][3][4] Men of all races and Black patients are less likely to be prescribed and fill opioids, [4][5][6] and co-prescribing of opioids and BZD is more likely among women and less likely among Black patients. 7,8 Despite concerns around the use of BZD and opioids among older adults due to the increased risk of adverse effects, research suggests that the use of these medications is increasingly prevalent in older adults.…”

Section: Introductionmentioning

confidence: 99%

“…Women are more likely to be prescribed and fill BZD prescriptions than men, and non‐White patients are less likely to be prescribed and fill BZDs compared to White patients 1–4 . Men of all races and Black patients are less likely to be prescribed and fill opioids, 4–6 and co‐prescribing of opioids and BZD is more likely among women and less likely among Black patients 7,8 …”

Section: Introductionmentioning

confidence: 99%

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Patterns and disparities in prescribing of opioids and benzodiazepines for older adults in North Carolina

Niznik

Hughes

Armistead

et al. 2023

J American Geriatrics Society

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Background We characterized real‐world prescribing patterns of opioids and benzodiazepines (BZDs) for older adults to explore potential disparities by race and sex and to characterize patterns of co‐prescribing. Methods A retrospective evaluation was conducted using electronic health data for adults ≥65 years old who presented to one of 15 primary care practices between 2019 and 2020 (n = 25,141). Chronic opioid and BZD users had ≥4 prescriptions in the year prior, with at least one in the last 90 or 180 days, respectively. We compared demographic characteristics between all older adults versus chronic opioid and BZD users. We used logistic regression to identify characteristics (age, sex, race, Medicaid use, fall history) associated with opioid and BZD co‐prescribing. Results We identified 833 (3.3%) chronic opioid and 959 chronic BZD users (3.8%) among all older adults seen in these practices. Chronic opioid users were less likely to be Black (12.7% vs. 14.3%) or other non‐White race (1.4% vs. 4.3%), but more likely to be women (66.8% vs. 61.3%). A similar trend was observed for BZD users, with less prescribing among Black (5.4% vs. 14.3%) and other races (2.2% vs. 4.3%) older adults and greater prescribing among women (73.6% vs. 61.3%). Co‐prescribing was observed among 15% of opioid users and 13% of BZD users. Co‐prescribing was largely driven by the presence of relevant co‐morbid conditions including chronic pain, anxiety, and insomnia rather than demographic characteristics. Conclusions We observed notable disparities in opioid and BZD prescribing by sex and race among older adults in primary care. Future research should explore if such patterns reflect appropriate prescribing or are due to disparities in prescribing driven by biases related to perceived risks for misuse.

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“…Opioids and BZDs are CNS-active medications that are challenging to appropriately prescribe and monitor, yet are commonly used in older adults [ 4 , 5 ]. Although these medications are frequently used in the treatment of pain, anxiety, and insomnia, they have also been shown to be associated with injurious falls in older adults, especially when used concurrently [ 3 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

A deprescribing medication program to evaluate falls in older adults: methods for a randomized pragmatic clinical trial

Niznik

Ferreri

Armistead

et al. 2022

Trials

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Background Opioids and benzodiazepines (BZDs) are some of the most commonly prescribed medications that contribute to falls in older adults. These medications are challenging to appropriately prescribe and monitor, with little guidance on safe prescribing of these medications for older patients. Only a handful of small studies have evaluated whether reducing opioid and BZD use through deprescribing has a positive impact on outcomes. Leveraging the strengths of a large health system, we evaluated the impact of a targeted consultant pharmacist intervention to deprescribe opioids and BZDs for older adults seen in primary care practices in North Carolina. Methods We developed a toolkit and process for deprescribing opioids and BZDs in older adults based on a literature review and guidance from an interprofessional team of pharmacists, geriatricians, and investigators. A total of fifteen primary care practices have been randomized to receive the targeted consultant pharmacist service (n = 8) or usual care (n = 7). The intervention consists of several components: (1) weekly automated reports to identify chronic users of opioids and BZDs, (2) clinical pharmacist medication review, and (3) recommendations for deprescribing and/or alternate therapies routed to prescribers through the electronic health record. We will collect data for all patients presenting one of the primary care clinics who meet the criteria for chronic use of opioids and/or BZDs, based on their prescription order history. We will use the year prior to evaluate baseline medication exposures using morphine milligram equivalents (MMEs) and diazepam milligram equivalents (DMEs). In the year following the intervention, we will evaluate changes in medication exposures and medication discontinuations between control and intervention clinics. Incident falls will be evaluated as a secondary outcome. To date, the study has enrolled 914 chronic opioid users and 1048 chronic BZD users. We anticipate that we will have 80% power to detect a 30% reduction in MMEs or DMEs. Discussion This clinic randomized pragmatic trial will contribute valuable evidence regarding the impact of pharmacist interventions to reduce falls in older adults through deprescribing of opioids and BZDs in primary care settings. Trial registration Clinicaltrials.govNCT04272671. Registered on February 17, 2020

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Opioid Prescribing in the 2016 Medicare Fee‐for‐Service Population

Cited by 7 publications

References 26 publications

Primary-Care Prescribers’ Perspectives on Deprescribing Opioids and Benzodiazepines in Older Adults

Primary-Care Prescribers’ Perspectives on Deprescribing Opioids and Benzodiazepines in Older Adults

Patterns and disparities in prescribing of opioids and benzodiazepines for older adults in North Carolina

A deprescribing medication program to evaluate falls in older adults: methods for a randomized pragmatic clinical trial

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