Open Access Open Access  Restricted Access Subscription or Fee Access

Concomitant use of benzodiazepines in chronic pain patients adherent to extended-release tapentadol or oxycodone treatment—A retrospective claims analysis

Vladimir Zah, PhD, Martina Imro, MSc, Simona Tatovic, MSc, Michael DeGeorge, PharmD, Steven D. Passik, PhD, Djurdja Vukicevic, PhD(c)

Abstract


Objective: To compare concomitant benzodiazepine (BZDs) use among chronic pain patients adherent to extended-release tapentadol (TapER) or oxycodone (OxnER) and estimate the number of lives potentially saved by switching patients to the less BZD coprescribed treatment.

Design: Retrospective database study.

Setting: Patients were identified using the IBM MarketScan® Commercial Database. The opioid overdose death estimates were obtained from the US national mortality register and were used to estimate the number of lives potentially saved by switching patients to the opioid treatment with lower rates of BZD coprescribing.

Patients, Participants: The authors identified 30,213 chronic pain patients between October 2012 and March 2016. After propensity score matching, N = 2,355 and N = 6,761 patients were adherent (proportion of days covered 80 percent) to TapER and OxnER, respectively.

Interventions: TapER versus OxnER, during the 180-day treatment.

Main Outcome Measure(s): Proportions of BZD coprescribing, BZD dosing patterns in matched patients, and the estimated number of lives potentially saved by the opioid treatment switch.

Results: TapER patients were less coprescribed BZDs during the treatment period (38.9 percent versus 49.2 percent, OR = 0.659, p < 0.001), and had fewer days of BZD supply per patient (mean: 49.6 versus 70.2 days, p < 0.001) with similar BZD average daily dose. Due to less frequent coprescribing of BZDs with TapER, it is estimated that ~800 deaths may have been avoided in the U.S. as a result of switching patients from OxnER to TapER.

Conclusions: Among treatment-adherent patients, TapER patients had fewer BZD coprescriptions than OxnER patients had. Moreover, when BZDs were coprescribed, those BZD prescriptions were for shorter periods of time. Prospective studies are warranted to explore rates and consequences of BZD coprescribing among opioids.


Keywords


long-acting opioids, benzodiazepines, concomitant treatment, tapentadol ER, oxycodone ER

Full Text:

PDF

References


Turk DC, Wilson HD, Cahana A: Treatment of chronic noncancer pain. The Lancet. 2011; 377(9784): 2226-2235.

National Institute on Drug Abuse: Opioid Overdose Crisis. 2018. Available at https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis. Accessed November 15, 2018.

Bolash RB: Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015; 372(16): 1573.

Vowles KE, McEntee ML, Julnes PS, et al.: Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Pain. 2015; 156(4): 569-576.

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, RTI International: National Survey on Drug Use and Health: Summary of National Findings. 2012. Available at https://www.samhsa.gov/data/sites/default/files/NSDUHresults2012/NSDUHresults2012.pdf. Accessed November 15, 2018.

Centers for Disease Control and Prevention: CDC guidelines for prescribing opioids for chronic pain. 2016. Available at http://www.cdc.gov/drugoverdose/prescribing/guideline.html. Accessed November 15, 2018.

CDC National Center for Injury Prevention and Control: Annual surveillance report of drug-related risks and outcomes. 2018. Available at https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf. Accessed November 15, 2018.

Ballantyne JC: Safe and effective when used as directed: The case of chronic use of opioid analgesics. J Med Toxicol. 2012; 8(4): 417-423.

Logan J, Liu Y, Paulozzi L, et al.: Opioid prescribing in emergency departments: the prevalence of potentially inappropriate prescribing and misuse. Med Care. 2013; 51(8): 646-653.

Landsman-Blumberg PB, Katz N, et al.: Health care resource use and cost differences by opioid therapy type among chronic noncancer pain patients. J Pain Res. 2017; 10: 1713-1722.

Park TW, Saitz R, Ganoczy D, et al.: Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: Case-cohort study. Br Med J. 2015; 350: h2698.

Gudin JA, Mogali S, Jones JD, et al.: Risks, management, and monitoring of combination opioid, benzodiazepines, and/ or alcohol use. Postgrad Med. 2013; 125(4): 115-130.

Alho H, Sinclair D, Vuori E, et al.: Abuse liability of buprenorphine- naloxone tablets in untreated IV drug users. Drug Alcohol Dependence. 2007; 88(1): 75-78.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States. JAMA. 2016; 315(15): 1624-1645.

Yarborough BJH, Stumbo SP, Stoneburner A, et al.: Correlates of benzodiazepine use and adverse outcomes among patients with chronic pain prescribed long-term opioid therapy. Pain Med. 2018; 20(6): 1148-1155.

Babalonis S, Walsh SL: Warnings unheeded: The risks of co-prescribing opioids and benzodiazepines. Pain Clin Update. 2015; 23(6): 1-7.

Afilalo M, Morlion B: Efficacy of tapentadol ER for managing moderate to severe chronic pain. Pain Phys. 2013; 16(1): 27-40.

Knezevic NN, Tverdohleb T, Knezevic I, et al.: Unique pharmacology of tapentadol for treating acute and chronic pain. Expert Opin Drug Metab Toxicol. 2015; 11(9): 1475-1492.

Murphy DL, Lebin JA, Severtson SG, et al.: Comparative rates of mortality and serious adverse effects among commonly prescribed opioid analgesics. Drug Saf. 2018; 41(8): 787-795.

Outhoff K: The pharmacology of anxiolytics. South African Family Pract. 2010; 52(2): 99-105.

Zhang Y, Huang G, Yang S, et al.: Duloxetine in treating generalized anxiety disorder in adults: A meta-analysis of published randomized, double-blind, placebo-controlled trials. Asia-Pacific Psych. 2016; 8(3): 215-225.

Kunz Y, Pinggera GM, Horninger W: PO-01-094 Novel real-time ultrasound-guided technique for intralesional injection of Xiapex (CCH)in the treatment of Peyronie's disease: Assessment of efficacy and adverse events rates. J Sexual Med. 2019; 16(5): S72.

IBM Watson Health: WHITE PAPER. IBM MarketScan Research Databases for Health Services Researchers. 2019. Available at https://www.ibm.com/downloads/cas/6KNYVVQ2.Accessed January 29, 2020.

Centers for Disease Control and Prevention: Multiple cause of death 1999-2016. [Internet]. Available at https://wonder.cdc.gov/mcd.html. Accessed November 15, 2018.

Zimolzak AJ, Spettell CM, Fernandes J, et al.: Early detection of poor adherers to statins: Applying individualized surveillance to pay for performance. PLoS One. 2013; 8(11): e79611.

Quan H, Sundararajan V, Halfon P, et al.: Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005; 43(11): 1130-1139.

Ashton H: Benzodiazepine equivalence table. 2001. Available at https://www.benzo.org.uk/bzequiv.htm. Accessed November 15, 2018.

Bezchlibnyk-Butler. Benzodiazepine equivalence chart. Available at http://www.mental-health-today.com/rx/benzo.htm. Accessed November 15, 2018.

Kane SP: Equivalent benzodiazepine calculator. 2017. Available at https://clincalc.com/Benzodiazepine/. Accessed November 15, 2018.

Dasgupta N, Funk MJ, Proescholdbell S, et al.: Cohort study of the impact of high-dose opioid analgesics on overdose mortality. Pain Med. 2016; 17(1): 85-98.

The Statistics Portal: Number of worldwide users of opioids 2015 and 2016. Available at https://www.statista.com/statistics/721265/number-of-worldwide-users-of-opioids-by-region/. Accessed November 15, 2018.

Sun EC, Dixit A, Humphreys K, et al.: Association between concurrent use of prescription opioids and benzodiazepines and overdose: Retrospective analysis. Br Med J. 2017; 356: j760.

Turner BJ, Liang Y: Drug overdose in a retrospective cohort with non-cancer pain treated with opioids, antidepressants, and/or sedative-hypnotics: Interactions with mental health disorders. J Gen Intern Med. 2015; 30(8): 1081-1096.

Sharp MJ, Melnik TA: Poisoning deaths involving opioid analgesics—New York State, 2003-2012. MMWR Morb Mortal Wkly Rep. 2015; 64(14): 377-380.

Whittington MD, Frank JW, Zeliadt S, et al.: Lives saved from reductions in co-prescribing of opioids and benzodiazepines. Paper presented at: International Society for Pharmacoeconomics and Outcomes Research (ISPOR), November 10-14, 2018; Barcelona, Spain. https://www.ispor.org/heor-resources/presentations-database/presentation/isporeurope-2018/lives-saved-from-reductions-in-co-prescribing-ofopioids-and-benzodiazepines.




DOI: https://doi.org/10.5055/jom.2020.0604

Refbacks

  • There are currently no refbacks.