Rates of Physician Coprescribing of Opioids and Benzodiazepines After the Release of the Centers for Disease Control and Prevention Guidelines in 2016

Jeffery, Molly Moore; Hooten, W. Michael; Jena, Anupam B.; Ross, Joseph S.; Shah, Nilay D.; Karaca‐Mandic, Pinar

doi:10.1001/jamanetworkopen.2019.8325

Cited by 48 publications

(70 citation statements)

References 37 publications

(44 reference statements)

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“…Only one other study was found that reported an 11.1% rate of opioid prescribing using 2016 data from primary care clinics in a Virginia PBRN ( Tong et al, 2019 ). The 52.1% rate of potential concurrent opioid-sedative prescription was also high compared to the recently published national figures of 23.0% for a commercially insured population and 25.7% for the Medicare Advantage population ( Jeffery et al, 2019 ). The notably higher rates of opioid prescribing among elders are consistent with prior reports ( Paulozzi, Strickler, Kreiner, & Koris, 2015 ).…”

Section: Discussionmentioning

confidence: 67%

Increasing collaboration on substance use disorder research with primary care practices through the National Drug Abuse Treatment Clinical Trials Network

Baldwin

Mollis

Witwer

et al. 2020

Journal of Substance Abuse Treatment

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Background: The National Drug Abuse Treatment Clinical Trials Network (CTN) called for its national nodes to promote the translation of evidence-based interventions from substance use disorder (SUD) research into clinical practices. This collaborative demonstration project engaged CTN-affiliated practice-based research networks (PBRNs) in research that describes aspects of opioid prescribing in primary care. Methods: Six PBRNs queried electronic health records from a convenience sample of 134 practices (84 participants) to identify the percent of adult patients with an office visit who were prescribed an opioid medication from October 1, 2015, to September 30, 2016, and, of those, the percent also prescribed a sedative in that year. Seven PBRNs sent an e-mail survey to a convenience sample of 108 practices (58 participants) about their opioid management policies and procedures during the project year. Results: Of 561,017 adult patients with a visit to one of the 84 clinics in the project year, 22.9% (PBRN range 3.1%–25.4%) were prescribed opioid medications, and 52.1% (PBRN range 8.5%–60.6%) of those were prescribed a sedative in the same year. Of the 58 practices returning a survey (45.3% response rate), 98.1% had formal written treatment agreements for chronic opioid therapy, 68.5% had written opioid prescribing policies, and 43.4% provided reports to providers with feedback on opioid management. Only 24.1% were providing buprenorphine for OUD. Conclusion: CTN-affiliated PBRNs demonstrated their ability to collaborate on a project related to opioid management; results highlight the important role for PBRNs in OUD treatment, research, and the need for interventions and additional policies addressing opioid prescribing in primary care practice.

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Section: Discussionmentioning

confidence: 67%

Increasing collaboration on substance use disorder research with primary care practices through the National Drug Abuse Treatment Clinical Trials Network

Baldwin

Mollis

Witwer

et al. 2020

Journal of Substance Abuse Treatment

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“…The overall number of consult requests decreased over time, similar to trends seen within the VA and in the community demonstrating overall reductions in prescribing of concurrent opioids and benzodiazepines. [22][23][24] A few strategies have been previously described with mixed results for efficacy in reducing concurrent use, including EMR review of current co-prescribed patients with individualized and/or standardized recommendations to prescribers, an electronic EMR alert at the time of prescription entry with information on risks and/or recommended provision of naloxone, and an electronic consult evaluated by CPS prior to prescribing new concurrent treatment. [11][12][13][14][15] This intervention at the SFVAHCS provides further evidence supporting electronic consult interventions as one strategy to reduce new concurrent treatment with opioids and benzodiazepines and may be useful in integrated health care systems that have not yet addressed new concurrent use and/or when reductions in co-prescribing have plateaued.…”

Section: Discussionmentioning

confidence: 99%

“…22,23 Furthermore, a retrospective cohort study which used insurance claims from a U.S. national database of medical and pharmacy claims demonstrated significant reductions in opioid and benzodiazepine coprescribing within the 2 years after publication of the Centers for Disease Control and Prevention guidelines in 2016, which recommended avoiding the combination. 24 Thus, providers within the SFVAHCS may have already received information about the risks of concurrent Consults were most commonly placed by primary care and mental health providers. This is likely because these are front line care services where patients typically access treatment for musculoskeletal pain, anxiety, and insomnia, the same common treatment indications identified in the retrospective review by Pardo et al 15 The highest number of consults were placed by providers at the main medical center, where there are multiple primary care and mental health clinics.…”

Section: Deceased Veteransmentioning

confidence: 99%

Evaluating implementation of a consult to reduce new combination opioid and benzodiazepine prescriptions at the San Francisco Veterans Affairs Health Care System

Rife

Zhao

et al. 2021

J Am Coll Clin Pharm

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IntroductionNational guidelines recommend against initiating concurrent opioids and benzodiazepines due to opioid overdose risk; however, limited evidence exists evaluating implementation strategies. The San Francisco Veterans Affairs Health Care System implemented an electronic clinical pharmacy specialist consult to evaluate new combination opioid and benzodiazepine requests. Reviewing pharmacists often recommend alternative therapies and safety strategies.ObjectivesThe primary objective of this study evaluated the outcome of consults placed (approved, short‐term approved, not approved, discontinued). Secondarily, types of recommendations made and implementation results after 1 month (implemented by prescriber, offered but patient declined, or not implemented) were evaluated.MethodsA retrospective electronic medical record review was completed for all consults requesting new combination opioids and benzodiazepines from February 19, 2016 to June 25, 2019. Descriptive statistics evaluated the consult request, treatment indication, and consult outcome. Linear regression evaluated the relationship between recommendations and number implemented.ResultsA total of 121 consults were placed and not approved (41%), discontinued (31%), short‐term approved (23%), or approved (5%). A total of 95 consults (79%) had ≥1 recommendation, and the most common were non‐benzodiazepine medication alternatives (42%), patient education (37%), and behavioral therapy (34%). Among those, 51% had ≥1 recommendation implemented, and the most common were patient education (36%), non‐benzodiazepine medication alternatives (29%), and specialty team referral (32%). Number of recommendations significantly predicted the number implemented by providers (P < .001).ConclusionImplementation of an electronic opioid and benzodiazepine new start consult evaluated by clinical pharmacy specialists resulted in a low rate of approval, reducing use of this risky combination. Among consults with ≥1 recommendation made, the implementation rate was high at >50%. Providing a variety of ≥5 recommendations increased the likelihood of implementation. Future research should examine the impact on reducing opioid‐related adverse events and engaging in recommended treatment alternatives.

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“…Deidentified administrative claims data from OptumLabs Data Warehouse include medical and pharmacy claims, laboratory results, and enrollment records for >88 million privately insured individuals during the study period. The database contains enrollees with a diverse mixture of ages and ethnicities across all 50 states in the United States 5 and has been used to evaluate health care expenditures and usage in oncology populations 6‐9 . The institutional review board of the University of Alabama at Birmingham approved our study.…”

Section: Methodsmentioning

confidence: 99%

“…The database contains enrollees with a diverse mixture of ages and ethnicities across all 50 states in the United States 5 and has been used to evaluate health care expenditures and usage in oncology populations. [6][7][8][9] The institutional review board of the University of Alabama at Birmingham approved our study.…”

Section: Data Sourcementioning

confidence: 99%

Expenditures among young adults with acute lymphoblastic leukemia by site of care

Wolfson

Bhatia

Ginsberg

et al. 2021

Cancer

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Background Individuals diagnosed with acute lymphoblastic leukemia (ALL) between the ages of 22 and 39 years experience worse outcomes than those diagnosed when they are 21 years old or younger. Treatment at National Cancer Institute–designated Comprehensive Cancer Centers (CCC) mitigates these disparities but may be associated with higher expenditures. Methods Using deidentified administrative claims data (OptumLabs Data Warehouse), the cancer‐related expenditures were examined among patients with ALL diagnosed between 2001 and 2014. Multivariable generalized linear model with log‐link modeled average monthly health‐plan–paid (HPP) expenditures and amount owed by the patient (out‐of‐pocket [OOP]). Cost ratios were used to calculate excess expenditures (CCC vs non‐CCC). Incidence rate ratios (IRRs) compared CCC and non‐CCC monthly visit rates. Models adjusted for sociodemographics, comorbidities, adverse events, and months enrolled. Results Clinical and sociodemographic characteristics were comparable between CCC (n = 160) and non‐CCC (n = 139) patients. Higher monthly outpatient expenditures in CCC patients ($15,792 vs $6404; P < .001) were driven by outpatient hospital HPP expenditures. Monthly visit rates and per visit expenditures for nonchemotherapy visits (IRR = 1.6; P = .001; CCC = $8247, non‐CCC = $1191) drove higher outpatient hospital expenditures among CCCs. Monthly OOP expenditures were higher at CCCs for outpatient care (P = .02). Inpatient HPP expenditures were significantly higher at CCCs ($25,918 vs $13,881; ꞵ = 0.9; P < .001) before accounting for adverse events but were no longer significant after adjusting for adverse events (ꞵ = 0.4; P = .1). Hospitalizations and length of stay were comparable. Conclusions Young adults with ALL at CCCs have higher expenditures, likely reflecting differences in facility structure, billing practices, and comprehensive patient care. It would be reasonable to consider CCCs comparable to the oncology care model and incentivize the framework to achieve superior outcomes and long‐term cost savings. Lay Summary Health care expenditures in young adults (aged 22‐39 years) with acute lymphoblastic leukemia (ALL) are higher among patients at National Cancer Institute‐designated Comprehensive Cancer Centers (CCC) than those at non‐CCCs. The CCC/non‐CCC differences are significant among outpatient expenditures, which are driven by higher rates of outpatient hospital visits and outpatient hospital expenditures per visit at CCCs. Higher expenditures and visit rates of outpatient hospital visits among CCCs may also reflect how facility structure and billing patterns influence spending or comprehensive care. Young adults at CCCs face higher inpatient HPP expenditures; these are driven by serious adverse events.

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Rates of Physician Coprescribing of Opioids and Benzodiazepines After the Release of the Centers for Disease Control and Prevention Guidelines in 2016

Cited by 48 publications

References 37 publications

Increasing collaboration on substance use disorder research with primary care practices through the National Drug Abuse Treatment Clinical Trials Network

Increasing collaboration on substance use disorder research with primary care practices through the National Drug Abuse Treatment Clinical Trials Network

Evaluating implementation of a consult to reduce new combination opioid and benzodiazepine prescriptions at the San Francisco Veterans Affairs Health Care System

Expenditures among young adults with acute lymphoblastic leukemia by site of care

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