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Did the CDC Opioid Guidelines Lead to a Drop in Opioid/Benzodiazepine Coprescription?

August 8, 2019
With CDC recommending avoiding coprescription, researchers investigated the fallout.

A PPM Brief

In the March 2016 US Centers for Disease Control and Prevention (CDC) guideline for opioid prescribing,1 a category included a recommendation to avoid coprescription of opioids and benzodiazepines “whenever possible.” Despite a few exceptions, the overall recommendation in the terms of long-term opioid use urged practitioners to avoid benzodiazepines whenever possible. A recent investigation2 looked to see if this recommendation led to an association with changes in the rate of coprescription of opioids and benzodiazepines.

In a retrospective cohort study from researchers at the Mayo Clinic and Massachusetts General Hospital, medical and pharmacy claims data was obtained for 3,598,322 (1,974,731 women [54.9%]) adult commercially insured patients and 1,299,142 Medicare Advantage (MA) beneficiaries (770,256 women [59.3%]). The patients chosen had no recent history of cancer, sickle cell disease, or hospice care, and used prescription opioids from January 1, 2014 through March 31, 2018.

Among 128,576 participants experiencing chronic pain episodes, more than one-half of person-months of long-term opioid use occurred in women (52.7% commercial insurance and 62.4% among MA beneficiaries). The median age of participants was 51 years for commercial insurance group patients and 70 years for the MA group.

With CDC recommending avoiding coprescription, researchers investigated the fallout. (Source: 123RF)

Results indicated that:

  • The mean extent of coprescription was 23.0% (0.18%) for the commercial insurance group and 25.7% (0.18%) for the MA group.
  • The extent of coprescription decreased in the targeted guideline population (individuals with long-term opioid use) after the 2016 guideline release dropped:
  • − 0.95 percentages point per year the commercial insurance group (postguideline slope, 95% CI, − 1.44 to − 0.46 percentage points per year)
  • − 1.06 percentage points per year in the MA group (95% CI, − 1.49 to − 0.63 percentage points per year).
  • Nontargeted short-term episodes of opioid use were associated with no change or small declines:
  • postguideline slope of −0.05 percentage point per year for the commercial insurance group, (95% CI, −0.12 to 0.02 percentage point per year).
  • postguideline slope of 0.47 percentage point per year for the MA group (95% CI, 0.35 - 0.59 percentage point per year)

The researchers also considered how common coprescription is, as well as how much overlap patients experience when they have coprescribed drugs (intensity), to which they found no change. “We also characterized coprescribing by the same physician vs the case when different physicians prescribe the opioids and benzodiazepines,” they wrote in their published results. “We found that most of the time, the same physician was prescribing both opioids and benzodiazepines and that when the same physician prescribed both opioids and benzodiazepines, the intensity of coprescription increased.” Therefore, coprescription was not driven by lack of information or coordination. The research team further theorized that physicians may be coprescribing opioids and benzodiazepines to treat co-occurring pain and mental health conditions, mainly after other treatments have failed.

“Future studies focused on identifying patterns of physician response to these guidelines may provide insight into who was affected by the guideline release on coprescription of opioids and benzodiazepines,” they concluded.

Last updated on: August 16, 2019
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