Department of Obstetrics and Gynecology and VCU Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Sleep. 2023 Jun 13;46(6). doi: 10.1093/sleep/zsad083.
In adult populations, women are more likely than men to be prescribed benzodiazepines. However, such disparities have not been investigated in people with opioid use disorder (OUD) and insomnia receiving buprenorphine, a population with particularly high sedative/hypnotic receipt. This retrospective cohort study used administrative claims data from Merative MarketScan Commercial and MultiState Medicaid Databases (2006-2016) to investigate sex differences in the receipt of insomnia medication prescriptions among patients in OUD treatment with buprenorphine.
We included people aged 12-64 years with diagnoses of insomnia and OUD-initiating buprenorphine during the study timeframe. The predictor variable was sex (female versus male). The primary outcome was receipt of insomnia medication prescription within 60 days of buprenorphine start, encompassing benzodiazepines, Z-drugs, or non-sedative/hypnotic insomnia medications (e.g. hydroxyzine, trazodone, and mirtazapine). Associations between sex and benzodiazepine, Z-drug, and other insomnia medication prescription receipt were estimated using Poisson regression models.
Our sample included 9510 individuals (female n = 4637; male n = 4873) initiating buprenorphine for OUD who also had insomnia, of whom 6569 (69.1%) received benzodiazepines, 3891 (40.9%) Z-drugs, and 8441 (88.8%) non-sedative/hypnotic medications. Poisson regression models, adjusting for sex differences in psychiatric comorbidities, found female sex to be associated with a slightly increased likelihood of prescription receipt: benzodiazepines (risk ratio [RR], RR = 1.17 [1.11-1.23]), Z-drugs (RR = 1.26 [1.18-1.34]), and non-sedative/hypnotic insomnia medication (RR = 1.07, [1.02-1.12]).
Sleep medications are commonly being prescribed to individuals with insomnia in OUD treatment with buprenorphine, with sex-based disparities indicating a higher prescribing impact among female than male OUD treatment patients.
在成年人群中，女性开具苯二氮䓬类药物的可能性高于男性。然而，在接受丁丙诺啡治疗的阿片类药物使用障碍（OUD）和失眠患者中，尚未对此类差异进行调查，而这些患者使用镇静/催眠药物的比例特别高。本回顾性队列研究使用 Merative MarketScan 商业和多州医疗补助数据库（2006-2016 年）的行政索赔数据，调查了接受丁丙诺啡治疗的 OUD 患者中，性别差异对失眠药物处方的影响。
我们纳入了年龄在 12-64 岁之间、在研究期间患有失眠和 OUD 并开始使用丁丙诺啡的患者。预测变量为性别（女性与男性）。主要结局是在丁丙诺啡开始后 60 天内开具失眠药物处方，包括苯二氮䓬类药物、Z 类药物或非镇静/催眠类失眠药物（如羟嗪、曲唑酮和米氮平）。使用泊松回归模型估计性别与苯二氮䓬类药物、Z 类药物和其他失眠药物处方开具之间的关系。
我们的样本包括 9510 名开始接受丁丙诺啡治疗 OUD 且同时患有失眠的个体（女性 n=4637；男性 n=4873），其中 6569 人（69.1%）开具了苯二氮䓬类药物，3891 人（40.9%）开具了 Z 类药物，8441 人（88.8%）开具了非镇静/催眠类失眠药物。调整精神病合并症性别差异的泊松回归模型发现，女性性别与开具处方的可能性略有增加有关：苯二氮䓬类药物（风险比[RR]，RR=1.17[1.11-1.23]）、Z 类药物（RR=1.26[1.18-1.34]）和非镇静/催眠类失眠药物（RR=1.07[1.02-1.12]）。
睡眠药物常用于接受丁丙诺啡治疗的 OUD 合并失眠患者，性别差异表明女性 OUD 治疗患者的处方影响高于男性。
