Trends in opioid prescribing and co-prescribing of sedative hypnotics for acute and chronic musculoskeletal pain: 2001-2010

Larochelle, Marc R.; Zhang, Fang; Ross‐Degnan, Dennis; Wharam, J. Frank

doi:10.1002/pds.3776

Cited by 103 publications

(80 citation statements)

References 26 publications

(73 reference statements)

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“…That is, we found support for increased risk of long-term opioid therapy in adulthood and youth related to SUDs, suicide attempts or other self-injury, motor vehicle crashes, and depressive, anxiety, and sleep disorders, as well as a broad array of psychoactive medications—including benzodiazepines [34]. Additionally, we found that the strongest risk for receipt of long-term opioids was associated with OUD diagnoses and treatment with buprenorphine or naltrexone.…”

Section: Discussionmentioning

confidence: 66%

Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims

Quinn

Hur

Chang

et al. 2017

Pain

100

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There is growing evidence that opioid prescribing in the US follows a pattern in which patients who are at highest risk of adverse outcomes from opioids are most likely to receive long-term opioid therapy. These patients include, in particular, those with substance use disorders (SUDs) and other psychiatric conditions. This study examined health insurance claims among 10 311 961 patients who filled prescriptions for opioids. Specifically, we evaluated how opioid receipt differed among patients with and without a wide range of pre-existing psychiatric and behavioral conditions (i.e., opioid and non-opioid SUDs, suicide attempts or other self-injury, motor vehicle crashes, and depressive, anxiety, and sleep disorders) and psychoactive medications (i.e., antidepressants, benzodiazepines, hypnotics, mood stabilizers, antipsychotics, and medications used for SUD, tobacco cessation, and attention-deficit/hyperactivity disorder [ADHD]). Relative to those without, patients with all assessed psychiatric conditions and medications had modestly greater odds of subsequently filling prescriptions for opioids and, in particular, substantially greater risk of long-term opioid receipt. Increases in risk for long-term opioid receipt in adjusted Cox regressions ranged from approximately 1.5-fold for prior ADHD medication prescriptions (hazard ratio [HR] = 1.53; 95% CI, 1.48–1.58) to approximately 3-fold for prior non-opioid SUD diagnoses (HR = 3.15; 95% CI, 3.06–3.24) and nearly 9-fold for prior opioid use disorder diagnoses (HR = 8.70; 95% CI, 8.20–9.24). In sum, we found evidence of greater opioid receipt among commercially insured patients with a breadth of psychiatric conditions. Future studies assessing behavioral outcomes associated with opioid prescribing should consider pre-existing psychiatric conditions.

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Section: Discussionmentioning

confidence: 66%

Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims

Quinn

Hur

Chang

et al. 2017

Pain

100

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“…Available death certificate reports seem unclear, but perhaps one third of death certificates listing overdose with an opiate as a cause of death also lists a benzodiazepine, Z hypnotic, or barbiturate as a cause of death (retrieved from CDC Wonder). An opioid prescription is more likely to lead to overdose when a hypnotic is prescribed 3 . There have also been several thousand yearly reported overdoses involving a hypnotic in which an opiate was not involved.…”

Section: Risks Of Hypnotic Drugsmentioning

confidence: 99%

“…This finding was not confirmed by one Taiwanese study 34 , but another Taiwanese study focusing on patients with sleep disturbances found that use of zolpidem was associated with 62%–91% increased hospitalizations for serious infections 35 . A Taiwan study of patients with chronic obstructive pulmonary disease found highly significant odds ratios associated with benzodiazepine use of 9.3 for pneumonia, 10.4 for acute chronic obstructive pulmonary disease (COPD) exacerbation, 45.0 for acute respiratory failure, and 18.6 for cardiopulmonary arrest; whereas the odds ratios for "Z" drugs such as zolpidem were of almost similar magnitude 3 . In confirmation, note in the Geisinger Health Study supplement, Table 7 16 , mortality hazard ratios were likewise specifically elevated among hypnotics users with COPD.…”

Section: Hypnotics Can Cause Serious and Potentially Lethal Infectionsmentioning

confidence: 99%

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Kripke

2016

F1000Res

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This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). This review includes new information on the growing USA overdose epidemic, eight new epidemiologic studies of hypnotics’ mortality not available for previous compilations, and new emphasis on risks of short-term hypnotic prescription. The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. The short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics are usually prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders might offer safer and more effective alternative approaches to insomnia.

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“…[1][2][3][4][5][6][7][8][9][10][11] Greater opioid prescribing contributed to increased opioid availability for abuse and overdose. [12][13][14] Primary care physicians (PCPs) and internists prescribe the majority of opioids.…”

Section: Introductionmentioning

confidence: 99%

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

et al. 2015

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BACKGROUND: Chronic opioid therapy for chronic pain treatment has increased. Hospital physicians, including hospitalists and medical/surgical resident physicians, care for many hospitalized patients, yet little is known about opioid prescribing at hospital discharge and future chronic opioid use. OBJECTIVE: We aimed to characterize opioid prescribing at hospital discharge among 'opioid naïve' patients. Opioid naïve patients had not filled an opioid prescription at an affiliated pharmacy 1 year preceding their hospital discharge. We also set out to quantify the risk of chronic opioid use and opioid refills 1 year post discharge among opioid naïve patients with and without opioid receipt at discharge. DESIGN: This was a retrospective cohort study. PARTICIPANTS: From 1 January 2011 to 31 December 2011, 6,689 opioid naïve patients were discharged from a safety-net hospital. MAIN MEASURE: Chronic opioid use 1 year post discharge. KEY RESULTS: Twenty-five percent of opioid naïve patients (n=1,688) had opioid receipt within 72 hours of discharge. Patients with opioid receipt were more likely to have diagnoses including neoplasm (6.3 % versus 3.5 %, p<0.001), acute pain (2.7 % versus 1.0 %, p<0.001), chronic pain at admission (12.1 % versus 3.3 %, p<0.001) or surgery during their hospitalization (65.1 % versus 18.4 %, p<0.001) compared to patients without opioid receipt. Patients with opioid receipt were less likely to have alcohol use disorders (15.7 % versus 20.7 %, p<0.001) and mental health disorders (23.9 % versus 31.4 %, p<0.001) compared to patients without opioid receipt. Chronic opioid use 1 year post discharge was more common among patients with opioid receipt (4.1 % versus 1.3 %, p<0.0001) compared to patients without opioid receipt. Opioid receipt was associated with increased odds of chronic opioid use (AOR=4.90, 95 % CI 3.22-7.45) and greater subsequent opioid refills (AOR=2.67, 95 % CI 2.29-3.13) 1 year post discharge compared to no opioid receipt. CONCLUSION:Opioid receipt at hospital discharge among opioid naïve patients increased future chronic opioid use. Physicians should inform patients of this risk prior to prescribing opioids at discharge.

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Trends in opioid prescribing and co-prescribing of sedative hypnotics for acute and chronic musculoskeletal pain: 2001-2010

Cited by 103 publications

References 26 publications

Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims

Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

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