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Assessing coprescription of opioids with central nervous system depressants for nonmalignant chronic musculoskeletal pain management in the outpatient setting

Rana Zalmai, PharmD, Walter Agbor Bawa, PharmD, Meredith Howard, PharmD, Rafia S. Rasu, PhD


Objectives: To determine annual prescribing trends of opioids and coprescription of central nervous system (CNS) depressants in nonmalignant chronic musculoskeletal pain from the National Ambulatory Medical Care Survey (NAMCS). To determine patient and provider characteristics associated with coprescription opioids and CNS depressants.

Design: The cross-sectional study analyzed NAMCS data from 2014 to 2016. Pain medications and CNS depressants were determined using Multum drug classification categories. All 30 medication entries were scanned in order to capture the maximum number of entries compared to previous studies. Multivariate logistic regressions were used to determine characteristics associated with opioid and CNS depressant coprescribing.

Participants: Adults (18 years and older) with nonmalignant chronic musculoskeletal pain diagnosis based on ICD-9 codes were identified as the reason for visit.

Results: A total of 47,973,413 weighted visits with nonmalignant chronic musculoskeletal pain were reported in the US ambulatory setting from 2014 to 2016. Amongst these patients, 31 percent were on opioids, of which 26 percent were also prescribed benzodiazepines, 8 percent NBSH, and 22 percent gabapentinoids. The annual prescribing rate of opioids decreased significantly in 2016 compared to 2014 (OR: 0.63, 95 percent CI: 0.43-0.94). Polypharmacy and tobacco use were associated with higher odds of having opioids and concurrent opioid with CNS depressants.

Conclusion: Our study results are in agreement with previous studies that found a steady decline in opioid prescribing even with the inclusion of all 30 medications in our study. Likewise, as previous studies have found, certain patient characteristics continue to be significant for receiving opioid and CNS depressant prescriptions.



musculoskeletal chronic pain, opioid, benzodiazepine, sedative, gabapentinoids

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