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Opioid, benzodiazepine coprescription slightly declines after boxed warning

The FDA boxed warning issued in 2016 highlighting the risks of coprescribing opioids and benzodiazepines was linked to a decrease in the number of patients with coprescriptions in the U.S., according to a research letter published in JAMA Psychiatry.

“Prior research examined trends before the warning and found a decrease in opioid prescribing after the March 2016 Centers for Disease Control and Prevention guideline,” Victoria (Shu) Zhang, PhD, from Yale University’s School of Management, and colleagues wrote. “However, it is not known whether coprescriptions further declined significantly after the boxed warning.”

Zhang and colleagues analyzed all benzodiazepine and opioid analgesic prescriptions in IQVIA LRx from January 2015 to December 2017 to determine the first national estimate of opioid and benzodiazepine coprescribing before and after the FDA boxed warning. They used interrupted time series to assess the connection between the boxed warning and coprescribing.

For each patient, researchers constructed prescription episodes as starting from the prescription dispense date until the number of days’ supply. Coprescription was defined an overlap of 1 day or longer between a patient’s opioid and benzodiazepine prescription episodes within a given month.

In 2015, Zhang and colleagues estimated that about 67.3 million U.S. patients filled either an opioid or benzodiazepine prescription.

After the boxed warning, analysis demonstrated a statistically significant change in the slope (–18.8; 95% CI, –25.1 to –12.4), which indicated a decrease of about 315,900 patients with coprescriptions from September 2016 to December 2017 (95% CI, –419,200 to –212,500) and a 17.9% relative reduction (95% CI, –23.7 to –12.1). In addition, on average, the monthly percentages of patients with coprescriptions declined both among those receiving opioids and those receiving benzodiazepines (0.8% [95% CI, 0.6-1] and 2.95% [95% CI, 2.3-3.5]).

The researchers also reported that women had a higher absolute decline in coprescription than men and older adults (aged 50 to 65 years) had the highest absolute declines of roughly –47,000 (95% CI, –62,500 to –31,500) among men and –82,900 (95% CI, –113,200 to –52,500) among women.

“Despite declining rates, a substantial number of U.S. adults, especially women 50 years and older, continue to be coprescribed opioids and benzodiazepines, underscoring the importance of closely monitoring specific patient populations, tapering either or both medications as clinically appropriate and considering alternative interventions,” Zhang and colleagues wrote. – by Savannah Demko

Disclosure: Zhang reports grants from the National Institute on Drug Abuse. Please see the study for all other authors’ relevant financial disclosures.