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      Co-prescription of opioids with benzodiazepine and other co-medications among opioid users: differential in opioid doses

      ,

      Journal of Pain Research

      Dove Medical Press

      co-prescription, opioid, benzodiazepine, co-medication, opioid users, pain

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          Abstract

          Purpose

          This study investigated the patterns of opioid co-prescription with benzodiazepine and other concomitant medications among opioid users. Opioid dose in each type of co-prescription was also examined.

          Patients and methods

          This cross-sectional study was conducted among opioid users receiving concomitant medications at an outpatient tertiary hospital setting in Malaysia. Opioid prescriptions (morphine, fentanyl, oxycodone, dihydrocodeine and tramadol) that were co-prescribed with other medications (opioid + benzodiazepines, opioid + antidepressants, opioid + anticonvulsants, opioid + antipsychotics and opioid + hypnotics) dispensed from January 2013 to December 2014 were identified. The number of patients, number of co-prescriptions and the individual mean opioid daily dose in each type of co-prescription were calculated.

          Results

          A total of 276 patients receiving 1059 co-prescription opioids with benzodiazepine and other co-medications were identified during the study period. Of these, 12.3% of patients received co-prescriptions of opioid + benzodiazepine, 19.3% received opioid + anticonvulsant, 6.3% received opioid + antidepressant and 10.9% received other co-prescriptions, including antipsychotics and hypnotics. The individual mean opioid dose was <100 mg/d of morphine equivalents in all types of co-prescriptions, and the dose ranged from 31 to 66 mg/d in the co-prescriptions of opioid + benzodiazepine.

          Conclusion

          Among the opioid users receiving concomitant medications, the co-prescriptions of opioid with benzodiazepine were prescribed to 12.3% of patients, and the individual opioid dose in this co-prescription was moderate. Other co-medications were also commonly used, and their opioid doses were within the recommended dose. Future studies are warranted to evaluate the adverse effect and clinical outcomes of the co-medications particularly in long-term opioid users with chronic non-cancer pain.

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          Most cited references 33

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          Association between mental health disorders, problem drug use, and regular prescription opioid use.

          Use of opioids for chronic noncancer pain is increasing, but standards of care for this practice are poorly defined. Psychiatric disorders are associated with increased physical symptoms such as pain and may be associated with opioid use, but no prospective population-based studies have addressed this issue. Analysis of longitudinal data from 6439 participants in the 1998 and 2001 waves of Healthcare for Communities, a nationally representative telephone community survey. Two hundred thirty-seven subjects (3.6%) reported regular prescription opioid use in 2001. In unadjusted logistic regression models, respondents with a common mental health disorder in 1998 (1165 [12.6%]; major depression, dysthymia, generalized anxiety disorder, or panic disorder) were more likely to report opioid use in 2001 than those without any of these disorders (odds ratio [OR], 4.43; 95% confidence interval [CI], 3.64-5.38; P<.001). Risk was increased for initiation (OR, 3.26; 95% CI, 2.44-4.34; P<.001) and continuation (OR, 2.30; 95% CI, 1.02-5.17; P = .04) of opioids. Respondents reporting problem drug use (136 [2.0%]; OR, 3.57; 95% CI, 2.32-5.50; P<.001) but not problem alcohol use (401 [6.5%]; OR, 0.73; 95% CI, 0.43-1.24; P = .25) reported higher rates of prescribed opioid use than those without problem use. In multivariate logistic regression models controlling for 1998 demographic and clinical variables, common mental health disorder (OR, 1.96; 95% CI, 1.47-2.62; P<.001) and problem drug use (OR, 2.98; 95% CI, 1.68-5.30; P<.001) remained significant predictors of opioid use in 2001. Common mental health disorders and problem drug use are associated with initiation and use of prescribed opioids in the general population. Attention to psychiatric disorders is important when considering opioid therapy.
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            Trends in use of opioids for non-cancer pain conditions 2000-2005 in commercial and Medicaid insurance plans: the TROUP study.

            Opioids are widely prescribed for non-cancer pain conditions (NCPC), but there have been no large observational studies in actual clinical practice assessing patterns of opioid use over extended periods of time. The TROUP (Trends and Risks of Opioid Use for Pain) study reports on trends in opioid therapy for NCPC in two disparate populations, one national and commercially insured population (HealthCore plan data) and one state-based and publicly-insured (Arkansas Medicaid) population over a six year period (2000-2005). We track enrollees with the four most common NCPC conditions: arthritis/joint pain, back pain, neck pain, headaches, as well as HIV/AIDS. Rates of NCPC diagnosis and opioid use increased linearly during this period in both groups, with the Medicaid group starting at higher rates and the HealthCore group increasing more rapidly. The proportion of enrollees receiving NCPC diagnoses increased (HealthCore 33%, Medicaid 9%), as did the proportion of enrollees with NCPC diagnoses who received opioids (HealthCore 58%, Medicaid 29%). Cumulative yearly opioid dose (in mg. morphine equivalents) received by NCPC patients treated with opioids increased (HealthCore 38%, Medicaid 37%) due to increases in number of days supplied rather than dose per day supplied. Use of short-acting Drug Enforcement Administration Schedule II opioids increased most rapidly, both in proportion of NCPC patients treated (HealthCore 54%, Medicaid 38%) and in cumulative yearly dose (HealthCore 95%, Medicaid 191%). These trends have occurred without any significant change in the underlying population prevalence of NCPC or new evidence of the efficacy of long-term opioid therapy and thus likely represent a broad-based shift in opioid treatment philosophy.
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              • Record: found
              • Abstract: found
              • Article: not found

              Prevalence and characteristics of opioid use in the US adult population.

              This report describes the prevalence of opioid use in the US adult population, overall and in subgroups, the characteristics of opioid use, and concomitant medication use among opioid users. Data were obtained from the Slone Survey, a population-based random-digit dialing survey. One household member was randomly selected to answer a series of questions regarding all medications taken during the previous week. There were 19,150 subjects aged > or = 18 interviewed from 1998 to 2006. Opioids were used 'regularly' ( > or = 5 days per week for > or = 4 weeks) by 2.0%; an additional 2.9% used opioids less frequently. Regular opioid use increased with age, decreased with education level, and was more common in females and in non-Hispanic whites. The prevalence of regular opioid use increased over time and was highest in the South Central region. Nearly one-fifth of regular users had been taking opioids for > or = 5 years. Concomitant use of > or = 10 non-opioid medications was reported by 21% of regular opioid users compared to 4.5% of subjects who did not use opioids. Regular opioid users were more likely to use stool softeners/laxatives (9% vs. 2%), proton pump inhibitors (25% vs. 8%), and antidepressants (35% vs. 10%). From this nationally-representative telephone survey, we estimate that over 4.3 million US adults are taking opioids regularly in any given week. Information on the prevalence and characteristics of use is important as opioids are one of the most widely prescribed classes of drugs in the US.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2017
                25 January 2017
                : 10
                : 249-257
                Affiliations
                Kulliyyah of Pharmacy, International Islamic University Malaysia, Bandar Indera Mahkota, Kuantan, Pahang, Malaysia
                Author notes
                Correspondence: Che Suraya Zin, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia, Tel +60 9 570 4909, Fax +60 9 571 6775, Email chesuraya@ 123456iium.edu.my
                Article
                jpr-10-249
                10.2147/JPR.S122853
                5279838
                © 2017 Zin and Ismail. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Anesthesiology & Pain management

                pain, opioid users, co-medication, benzodiazepine, opioid, co-prescription

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