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Benzodiazepine-opioid co-prescribing in a national probability sample of ED encounters.
Am J Emerg Med. 2017 Mar; 35(3):458-464.AJ

Abstract

BACKGROUND

Benzodiazepine-opioid combination therapy is potentially harmful due to the risk of synergistic respiratory depression, and the rate of death due to benzodiazepine-opioid overdose is increasing. Little is known about the prevalence and characteristics of benzodiazepine-opioid co-prescribing from the ED setting.

METHODS

Secondary analysis of data from the National Hospital Ambulatory Medical Care Survey, using sample weights to generate population estimates. The primary objective was to describe the annual prevalence of benzodiazepine-opioid co-prescribing from 2006 to 2012, using 95% confidence intervals (95% CI) to compare adjacent years. The secondary objective was to compare characteristics of ED encounters receiving a benzodiazepine-opioid co-prescription versus those receiving an opioid prescription alone, using a multivariable logistic regression.

RESULTS

The prevalence of benzodiazepine-opioid co-prescribing did not significantly change from 2006 to 2012. During this period, 2.7% (95% CI: 2.5-2.8%) of ED encounters prescribed an opioid were also prescribed a benzodiazepine. Relative to encounters receiving an opioid prescription alone, encounters receiving a co-prescription were more likely to represent a follow-up rather than initial visit (Odds Ratio [OR] 1.52), receive more medications (OR 1.41) and fewer procedures (OR 0.48) while in the ED, and more likely to have a diagnosis related to mental disorder (OR 20.60) or musculoskeletal problem (OR 3.71).

CONCLUSIONS

From 2006 to 2012, almost 3% of all ED encounters receiving an opioid prescription also received a benzodiazepine co-prescription. The odds of benzodiazepine-opioid co-prescribing were significantly higher in ED encounters representing a follow-up visit and in diagnoses relating to a mental disorder or musculoskeletal problem.

Authors+Show Affiliations

Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. Electronic address: howard.kim@northwestern.edu.Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.Department of Communication Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27923527

Citation

Kim, Howard S., et al. "Benzodiazepine-opioid Co-prescribing in a National Probability Sample of ED Encounters." The American Journal of Emergency Medicine, vol. 35, no. 3, 2017, pp. 458-464.
Kim HS, McCarthy DM, Mark Courtney D, et al. Benzodiazepine-opioid co-prescribing in a national probability sample of ED encounters. Am J Emerg Med. 2017;35(3):458-464.
Kim, H. S., McCarthy, D. M., Mark Courtney, D., Lank, P. M., & Lambert, B. L. (2017). Benzodiazepine-opioid co-prescribing in a national probability sample of ED encounters. The American Journal of Emergency Medicine, 35(3), 458-464. https://doi.org/10.1016/j.ajem.2016.11.054
Kim HS, et al. Benzodiazepine-opioid Co-prescribing in a National Probability Sample of ED Encounters. Am J Emerg Med. 2017;35(3):458-464. PubMed PMID: 27923527.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Benzodiazepine-opioid co-prescribing in a national probability sample of ED encounters. AU - Kim,Howard S, AU - McCarthy,Danielle M, AU - Mark Courtney,D, AU - Lank,Patrick M, AU - Lambert,Bruce L, Y1 - 2016/12/02/ PY - 2016/07/24/received PY - 2016/11/21/revised PY - 2016/11/28/accepted PY - 2016/12/8/pubmed PY - 2017/5/4/medline PY - 2016/12/8/entrez KW - Benzodiazepine KW - Opioid KW - Pain KW - Prescribing SP - 458 EP - 464 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 35 IS - 3 N2 - BACKGROUND: Benzodiazepine-opioid combination therapy is potentially harmful due to the risk of synergistic respiratory depression, and the rate of death due to benzodiazepine-opioid overdose is increasing. Little is known about the prevalence and characteristics of benzodiazepine-opioid co-prescribing from the ED setting. METHODS: Secondary analysis of data from the National Hospital Ambulatory Medical Care Survey, using sample weights to generate population estimates. The primary objective was to describe the annual prevalence of benzodiazepine-opioid co-prescribing from 2006 to 2012, using 95% confidence intervals (95% CI) to compare adjacent years. The secondary objective was to compare characteristics of ED encounters receiving a benzodiazepine-opioid co-prescription versus those receiving an opioid prescription alone, using a multivariable logistic regression. RESULTS: The prevalence of benzodiazepine-opioid co-prescribing did not significantly change from 2006 to 2012. During this period, 2.7% (95% CI: 2.5-2.8%) of ED encounters prescribed an opioid were also prescribed a benzodiazepine. Relative to encounters receiving an opioid prescription alone, encounters receiving a co-prescription were more likely to represent a follow-up rather than initial visit (Odds Ratio [OR] 1.52), receive more medications (OR 1.41) and fewer procedures (OR 0.48) while in the ED, and more likely to have a diagnosis related to mental disorder (OR 20.60) or musculoskeletal problem (OR 3.71). CONCLUSIONS: From 2006 to 2012, almost 3% of all ED encounters receiving an opioid prescription also received a benzodiazepine co-prescription. The odds of benzodiazepine-opioid co-prescribing were significantly higher in ED encounters representing a follow-up visit and in diagnoses relating to a mental disorder or musculoskeletal problem. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/27923527/Benzodiazepine_opioid_co_prescribing_in_a_national_probability_sample_of_ED_encounters_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(16)30889-0 DB - PRIME DP - Unbound Medicine ER -