Concomitant use of opioids and benzodiazepines in the outpatient setting.

BACKGROUND

Benzodiazepines have been identified as a concurrent factor in opioid related deaths. Although the dangers of concomitant administration of opioids and benzodiazepines are well documented, implementation of this knowledge into practice may be lagging behind.

OBJECTIVE

To examine the concomitant use of opioids and benzodiazepines in the outpatient setting.

DESIGN

Retrospective study.

SETTING

Academic outpatient multispecialty practice.

PARTICIPANTS

Over 2000 outpatient clinic visits from January 2018 to April 2018 among 4 Physiatrists were analyzed.

METHODS

All patients were reviewed in the Prescription Drug Monitoring Program (PDMP) website to identify if they have filled either opioid or benzodiazepine prescription(s) in the last 12 months.

MAIN OUTCOME MEASUREMENTS: Number of opioid and benzodiazepine prescriptions, discrepancies in reporting of medications, providers prescribing medications, and cigarette/alcohol use.

RESULTS

353 patients were identified to have filled either opioid or benzodiazepine prescription(s) in last 12 months. 49.4% of patients prescribed opioids were found to be on benzodiazepines concurrently. Reporting discrepancies were noted between the outpatient electronic medical record and PDMP in 17.2% of patients. Among patients on both opioids and benzodiazepines, 38.9% had multiple providers prescribing these medications, 41.9% were over 65 years old, and 11.9% were daily cigarette/alcohol users. Patients on both types of drugs (opioids and benzodiazepines) were significantly more likely to use different providers (38.9%) compared to patients on one type of drug (9.8%, p<.001). The former group was also noted to fill significantly more prescriptions than the latter group (p<.001).

CONCLUSION

The study results emphasize clinicians may not be aware that some of their patients are concurrently taking both opioids and benzodiazepines, hence highlights the importance of routinely checking the PDMP and utilizing that information to make fully informed decisions regarding the safest possible way to prescribe these controlled substances.

LEVEL OF EVIDENCE: III.