Neurology, The University of Texas Medical Branch, Galveston, Texas, USA.
Division of Geriatrics and Palliative Medicine & Sealy Center on Aging, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA.
BMJ Open. 2021 Nov 18;11(11):e053487. doi: 10.1136/bmjopen-2021-053487.
Opioid and benzodiazepine co-prescribing is associated with a substantial increase in opioid overdose deaths. In this study, we examine the prescribing trends of substitutes of opioids and benzodiazepines alone or in combination, compared with opioids and benzodiazepines.
Retrospective cohort study.
Data were collected using a 20% national sample of Medicare beneficiaries from 2013 to 2018.
4.1-4.3 million enrollees each year from 2013 to 2018.
None.
We employ a generalised linear mixed models to calculate ORs for opioid use, benzodiazepine or Z-drug (benzos/Z-drugs) use, opioid/benzos/Z-drugs 30-day use, gabapentinoid use and (selective serotonin reuptake inhibitors (SSRI) and serotonin norepinephrine reuptake inhibitors (SNRIs)) use, adjusted for the repeated measure of patient. We then created two models to calculate the ORs for each year and comparing to 2013.
Opioid and benzos/Z-drugs use decreased by 2018 (aOR 0.626; 95% CI 0.622 to 0.630) comparing to 2013. We demonstrate a 36.3% and 9.9% increase rate of gabapentinoid and SSRI/SNRI use, respectively. Furthermore, combined gabapentinoid and SSRI/SNRI use increased in 2018 (aOR 1.422; 95% CI 1.412 to 1.431).
Little is known about the prescribing pattern and trend of opioid and benzodiazepine alternatives as analgesics. There is a modest shift from prescribing opioid and benzos/Z-drugs (alone or in combination) towards prescribing non-opioid analgesics-gabapentinoids with and without non-benzos/Z-drugs that are indicated for anxiety. It is unclear if this trend towards opioid/benzos/Z-drugs alternatives is associated with fewer drug overdose death, better control of pain and comorbid anxiety, and improved quality of life.
阿片类药物和苯二氮䓬类药物联合处方与阿片类药物过量死亡显著增加有关。本研究旨在检查单独或联合使用阿片类药物和苯二氮䓬类药物替代品的处方趋势，并与阿片类药物和苯二氮䓬类药物进行比较。
回顾性队列研究。
数据来自 2013 年至 2018 年 20%的全国医疗保险受益人的样本。
每年有 410 万至 430 万参保人，来自 2013 年至 2018 年。
无。
我们采用广义线性混合模型计算阿片类药物使用、苯二氮䓬类药物或 Z 类药物（苯二氮䓬类药物/Z 类药物）使用、阿片类药物/苯二氮䓬类药物/Z 类药物 30 天使用、加巴喷丁类药物和（选择性 5-羟色胺再摄取抑制剂（SSRIs）和 5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs））使用的比值比（OR），并针对患者的重复测量进行调整。然后，我们创建了两个模型来计算每年的 OR，并与 2013 年进行比较。
与 2013 年相比，2018 年阿片类药物和苯二氮䓬类药物/Z 类药物的使用减少了 20%（aOR 0.626；95%CI 0.622 至 0.630）。我们分别显示加巴喷丁类药物和 SSRIs/SNRIs 的使用增加了 36.3%和 9.9%。此外，2018 年联合使用加巴喷丁类药物和 SSRIs/SNRIs 的比例增加（aOR 1.422；95%CI 1.412 至 1.431）。
人们对阿片类药物和苯二氮䓬类药物替代品作为镇痛药的处方模式和趋势知之甚少。从处方阿片类药物和苯二氮䓬类药物（单独或联合使用）向处方非阿片类镇痛药-加巴喷丁类药物转变，同时处方非苯二氮䓬类药物/Z 类药物用于治疗焦虑症。目前尚不清楚这种阿片类药物/苯二氮䓬类药物替代品的趋势是否与药物过量死亡减少、疼痛更好控制、共病焦虑减轻以及生活质量提高有关。
