Patterns of Opioid and Benzodiazepine Use in Opioid-Naïve Patients with Newly Diagnosed Low Back and Lower Extremity Pain

Abstract

BACKGROUND: The morbidity and mortality associated with opioid and benzodiazepine co-prescription is a pressing national concern. Little is known about patterns of opioid and benzodiazepine use in patients with acute low back pain or lower extremity pain. OBJECTIVE: To characterize patterns of opioid and benzodiazepine prescribing among opioid-naïve, newly diagnosed low back pain (LBP) or lower extremity pain (LEP) patients and to investigate the relationship between benzodiazepine prescribing and long-term opioid use. DESIGN/SETTING: We performed a retrospective analysis of a commercial database containing claims for more than 75 million enrollees in the USA. PARTICIPANTS: Participants were adult patients newly diagnosed with LBP or LEP between 2008 and 2015 who did not have a red flag diagnosis, had not received an opioid prescription in the 6 months prior to diagnosis, and had 12 months of continuous enrollment after diagnosis. MAIN OUTCOMES AND MEASURES: Among patients receiving at least one opioid prescription within 12 months of diagnosis, we defined discrete patterns of benzodiazepine prescribing-continued use, new use, stopped use, and never use. We tested the association of these prescription patterns with long-term opioid use, defined as six or more fills within 12 months. RESULTS: We identified 2,497,653 opioid-naïve patients with newly diagnosed LBP or LEP. Between 2008 and 2015, 31.9% and 11.5% of these patients received opioid and benzodiazepine prescriptions, respectively, within 12 months of diagnosis. Rates of opioid prescription decreased from 34.8% in 2008 to 27.0% in 2015 (P < 0.001); however, prescribing of benzodiazepines only decreased from 11.6% in 2008 to 10.8% in 2015. Patients with continued or new benzodiazepine use consistently used more opioids than patients who never used or stopped using benzodiazepines during the study period (one-way ANOVA, P < 0.001). For patients with continued and new benzodiazepine use, the odds ratio of long-term opioid use compared with those never prescribed a benzodiazepine was 2.99 (95% CI, 2.89-3.08) and 2.68 (95% CI, 2.62-2.75), respectively. LIMITATIONS: This study used administrative claims analyses, which rely on accuracy and completeness of diagnostic, procedural, and prescription codes. CONCLUSION: Overall opioid prescribing for low back pain or lower extremity pain decreased substantially during the study period, indicating a shift in management within the medical community. Rates of benzodiazepine prescribing, however, remained at approximately 11%. Concurrent prescriptions of benzodiazepines and opioids after LBP or LEP diagnosis were associated with increased risk of long-term opioid use.

Treatment Patterns in Patients with Diagnostic Imaging for Low Back Pain: A Retrospective Observational Study

“…Despite the questionable effect of opioids in acute LBP 21 and the evidence of poorer outcomes compared to non-opioid treatments, 22,23 opioids are still frequently prescribed for patients with LBP. 5,[24][25][26] In our study 34% of all patients received an opioid. Comparing this percentage of opioid use to the sparse national comparative data, 20 we found that the percentage in our study was almost twice as high.…”

New and persistent controlled substance use among patients undergoing mastectomy and reconstructive surgery

“…We found that 70.9% of new persistent opioid users lled a sedative-hypnotic prescription during the study period as well, while 98.2% of new persistent sedativehypnotic users lled an opioid prescription. Sedative-hypnotics are known to potentiate the respiratory depressive effects of opioids [33], and concomitant opioid and sedative-hypnotic use has been associated with increased rates of long-term opioid use, opioid overdose and all-cause mortality [34][35][36][37]. In particular, pre-operative sedative-hypnotic use among opioid-naïve patients increases the risk of long-term opioid use post-operatively [38].…”

New and Persistent Controlled Substance Use Among Patients Undergoing Mastectomy and Reconstructive Surgery

“…We found that 70.9% of new persistent opioid users lled a sedative-hypnotic prescription during the study period as well, while 98.2% of new persistent sedativehypnotic users lled an opioid prescription. Sedative-hypnotics are known to potentiate the respiratory depressive effects of opioids [33], and concomitant opioid and sedative-hypnotic use has been associated with increased rates of long-term opioid use, opioid overdose and all-cause mortality [34][35][36][37]. In particular, pre-operative sedative-hypnotic use among opioid-naïve patients increases the risk of long-term opioid use post-operatively [38].…”