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Characterisation of concurrent use of prescription opioids and benzodiazepine/Z-drugs in Alberta, Canada: a population-based study

OBJECTIVE: The objective of this study is to characterise concurrent use of benzodiazepine receptor modulators and opioids among prescription opioid users in Alberta in 2017. DESIGN: A population based retrospective study. SETTING: Alberta, Canada, in the year 2017. PARTICIPANTS: All individuals in...

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Autores principales: Sharma, Vishal, Weir, Daniala, Samanani, Salim, Simpson, Scot H, Gilani, Fizza, Jess, Ed, Eurich, Dean T
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731882/
https://www.ncbi.nlm.nih.gov/pubmed/31494618
http://dx.doi.org/10.1136/bmjopen-2019-030858
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author Sharma, Vishal
Weir, Daniala
Samanani, Salim
Simpson, Scot H
Gilani, Fizza
Jess, Ed
Eurich, Dean T
author_facet Sharma, Vishal
Weir, Daniala
Samanani, Salim
Simpson, Scot H
Gilani, Fizza
Jess, Ed
Eurich, Dean T
author_sort Sharma, Vishal
collection PubMed
description OBJECTIVE: The objective of this study is to characterise concurrent use of benzodiazepine receptor modulators and opioids among prescription opioid users in Alberta in 2017. DESIGN: A population based retrospective study. SETTING: Alberta, Canada, in the year 2017. PARTICIPANTS: All individuals in Alberta, Canada, with at least one dispensation record from a community pharmacy for an opioid in the year 2017. EXPOSURE: Concurrent use of a benzodiazepine receptor modulator and opioid, defined as overlap of supply for both drugs for at least 1 day. MAIN OUTCOME MEASURES: Prevalence of concurrency was estimated among subgroups of patient characteristics that were considered clinically relevant or associated with inappropriate medication use. RESULTS: Among the 547 709 Albertans who were dispensed opioid prescriptions in 2017, 132 156 (24%) also received prescriptions for benzodiazepine receptor modulators. There were 96 581 (17.6%) prescription opioid users who concurrently used benzodiazepine receptor modulators with an average of 98 days (SD=114, 95% CI 97 to 99) of total cumulative concurrency and a median of 37 days (IQR 10 to 171). The average longest duration of consecutive days of concurrency was 45 (SD=60, 95% CI 44.6 to 45.4) with a median of 24 days (IQR 8 to 59). Concurrency was more prevalent in females, patients using an average daily oral morphine equivalent >90 mg, opioid dependence therapy patients, chronic opioid users, patients utilising a high number of unique providers, lower median household incomes and those older than 65 (p value<0.001 for all comparisons). CONCLUSIONS: Concurrent prescribing of opioids and benzodiazepine receptor modulators is common in Alberta despite the ongoing guidance of many clinical resources. Older patients, those taking higher doses of opioids, and for longer durations may be at particular risk of adverse outcomes and may be worthy of closer follow-up for assessment for dose tapering or discontinuations. As well, those with higher healthcare utilisation (seeking multiple providers) should also be closely monitored. Continued surveillance of concurrent use of these medications is warranted to ensure that safe drug use recommendations are being followed by health providers.
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spelling pubmed-67318822019-09-20 Characterisation of concurrent use of prescription opioids and benzodiazepine/Z-drugs in Alberta, Canada: a population-based study Sharma, Vishal Weir, Daniala Samanani, Salim Simpson, Scot H Gilani, Fizza Jess, Ed Eurich, Dean T BMJ Open Epidemiology OBJECTIVE: The objective of this study is to characterise concurrent use of benzodiazepine receptor modulators and opioids among prescription opioid users in Alberta in 2017. DESIGN: A population based retrospective study. SETTING: Alberta, Canada, in the year 2017. PARTICIPANTS: All individuals in Alberta, Canada, with at least one dispensation record from a community pharmacy for an opioid in the year 2017. EXPOSURE: Concurrent use of a benzodiazepine receptor modulator and opioid, defined as overlap of supply for both drugs for at least 1 day. MAIN OUTCOME MEASURES: Prevalence of concurrency was estimated among subgroups of patient characteristics that were considered clinically relevant or associated with inappropriate medication use. RESULTS: Among the 547 709 Albertans who were dispensed opioid prescriptions in 2017, 132 156 (24%) also received prescriptions for benzodiazepine receptor modulators. There were 96 581 (17.6%) prescription opioid users who concurrently used benzodiazepine receptor modulators with an average of 98 days (SD=114, 95% CI 97 to 99) of total cumulative concurrency and a median of 37 days (IQR 10 to 171). The average longest duration of consecutive days of concurrency was 45 (SD=60, 95% CI 44.6 to 45.4) with a median of 24 days (IQR 8 to 59). Concurrency was more prevalent in females, patients using an average daily oral morphine equivalent >90 mg, opioid dependence therapy patients, chronic opioid users, patients utilising a high number of unique providers, lower median household incomes and those older than 65 (p value<0.001 for all comparisons). CONCLUSIONS: Concurrent prescribing of opioids and benzodiazepine receptor modulators is common in Alberta despite the ongoing guidance of many clinical resources. Older patients, those taking higher doses of opioids, and for longer durations may be at particular risk of adverse outcomes and may be worthy of closer follow-up for assessment for dose tapering or discontinuations. As well, those with higher healthcare utilisation (seeking multiple providers) should also be closely monitored. Continued surveillance of concurrent use of these medications is warranted to ensure that safe drug use recommendations are being followed by health providers. BMJ Publishing Group 2019-09-06 /pmc/articles/PMC6731882/ /pubmed/31494618 http://dx.doi.org/10.1136/bmjopen-2019-030858 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Epidemiology
Sharma, Vishal
Weir, Daniala
Samanani, Salim
Simpson, Scot H
Gilani, Fizza
Jess, Ed
Eurich, Dean T
Characterisation of concurrent use of prescription opioids and benzodiazepine/Z-drugs in Alberta, Canada: a population-based study
title Characterisation of concurrent use of prescription opioids and benzodiazepine/Z-drugs in Alberta, Canada: a population-based study
title_full Characterisation of concurrent use of prescription opioids and benzodiazepine/Z-drugs in Alberta, Canada: a population-based study
title_fullStr Characterisation of concurrent use of prescription opioids and benzodiazepine/Z-drugs in Alberta, Canada: a population-based study
title_full_unstemmed Characterisation of concurrent use of prescription opioids and benzodiazepine/Z-drugs in Alberta, Canada: a population-based study
title_short Characterisation of concurrent use of prescription opioids and benzodiazepine/Z-drugs in Alberta, Canada: a population-based study
title_sort characterisation of concurrent use of prescription opioids and benzodiazepine/z-drugs in alberta, canada: a population-based study
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731882/
https://www.ncbi.nlm.nih.gov/pubmed/31494618
http://dx.doi.org/10.1136/bmjopen-2019-030858
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