Why Haven't Rates of Dangerous Co-Prescribing Dropped?
Although rates of opioid prescribing reached a plateau from 2006–2010, the co-prescribing of opioids and sedative hypnotics did not decrease over a nine-year period despite guidelines that advise against co-prescribing of these medications.
In this study published in the journal Pharmacoepidemiology & Drug Safety, Marc LaRochelle, MD, from the Boston University School of Medicine, and colleagues reviewed data on 15,344 office visits for acute pain and 19,958 visits for chronic pain from the National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey from 2001–2010 to determine trends in opioid prescribing and co-prescribing of sedative hypnotics. The primary outcome was a new prescription, or continuation of an opioid medication during the visit; the secondary outcome was prescribing of sedative hypnotics.
Over nine years, opioid prescribing at acute musculoskeletal pain visits increased from 10.4% to 15.6% and from 12.9% to 23.1% for chronic musculoskeletal pain. For chronic pain visits, opioid prescribing peaked in 2007 at 28.2% of visits. Benzodiazepines were co-prescribed with opioids during 8.1% of acute pain visits and 15.5% of chronic pain visits while sedative hypnotics were co-prescribed at 32.7% of acute pain visits and 36.1% of chronic pain visits. There was no evidence for decreased co-prescribing of opioids and sedative hypnotics. Patients with psychiatric and substance abuse disorders were also more likely to be co-prescribed high-dose opioids and sedatives. Opioid prescribing did not vary by age group for acute pain visits, but patients aged 35–49 were more likely to receive an opioid for chronic pain vs. patients aged 50–64.
In an accompanying editorial Mark D. Sullivan, MD, from the University of Washington in Seattle, hypothesized that high rates of comorbidity among chronic pain and psychiatric disorders could be driving this co-prescribing. Improved prescriber education could help clinicians better understand the risks and benefits associated with prescription opioids and sedative hypnotics.
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