Prescription characteristics associated with drug overdose risk among adults prescribed benzodiazepines: a cohort study

BMC Pharmacology and Toxicology

Research Article

Julie Strominger¹  Amy S. B. Bohnert²  Donovan T. Maust³  Jason E. Goldstick⁴ 

[1] Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA;Injury Prevention Center, University of Michigan, 48109, Ann Arbor, MI, USA;Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA;Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA;Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA;Injury Prevention Center, University of Michigan, 48109, Ann Arbor, MI, USA;Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA;Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA;Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA;Injury Prevention Center, University of Michigan, 48109, Ann Arbor, MI, USA;Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA;Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA;

关键词: Benzodiazepine;    Cox proportional hazards;    Medication possession ratio;    Overdose;    Poisoning;   

DOI  :  10.1186/s40360-023-00674-x

 received in 2022-05-19, accepted in 2023-05-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDrug overdose (OD) deaths in the U.S. continue to rise. After opioids, benzodiazepines (BZD) are the medication most commonly involved in prescription overdoses, yet OD risk factors among those prescribed BZD are not well understood. Our objective was to examine characteristics of BZD, opioid, and other psychotropic prescriptions associated with increased drug OD risk following a BZD prescription.MethodsWe completed a retrospective cohort study using a 20% sample of Medicare beneficiaries with prescription drug coverage. We identified patients with a BZD prescription (“index”) claim between 1 April 2016 and 31 December 2017. In the 6 months pre-index, those without and with BZD claims comprised incident and continuing cohorts, which were split by age (incident < 65 [n = 105,737], 65 + [n = 385,951]; continuing < 65 [n =  240,358], 65 + [n = 508,230]). Exposures of interest were: average daily dose and days prescribed of the index BZD; baseline BZD medication possession ratio (MPR) for the continuing cohort; co-prescribed opioids and psychotropics. Our primary outcome was a treated drug OD event (including accidental, intentional, undetermined, or adverse effect) within 30 days of the index BZD, examined using Cox proportional hazards.ResultsAmong incident and continuing BZD cohorts, 0.78% and 0.56% experienced an OD event. Compared to 14–30 days, a < 14-day fill corresponded to higher OD risk in incident (< 65 adjusted hazard ratio [aHR] 1.16 [95% CI 1.03–1.31]; 65 + : aHR 1.21 [CI 1.13–1.30]) and continuing (< 65: aHR 1.33 [CI 1.15–1.53]; 65 + : aHR 1.43 [CI 1.30–1.57]) cohorts. Among continuing users, lower baseline exposure (i.e., MPR < 0.5) was associated with increased OD risk for those < 65 (aHR 1.20 [CI 1.06–1.36]); 65 + (aHR 1.12 [CI 1.01–1.24]). Along with opioids, concurrent antipsychotic use and antiepileptic use were associated with elevated risk of OD in all 4 cohorts (e.g., aHRs for the continuing 65 + cohort: opioid, 1.73 [CI 1.58–1.90]; antipsychotic, 1.33 [CI 1.18–1.50]; antiepileptic, 1.18 [1.08–1.30]).ConclusionsIn both the incident and continuing cohorts, patients dispensed fewer days' supply were at increased OD risk; those in the continuing cohort with more limited baseline BZD exposure were also at elevated risk. Concurrent medication exposures including opioids, antipsychotics, and antiepileptics were associated with short-term elevated OD risk.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 3

40517_2023_256_Article_IEq1.gif

40517_2023_256_Article_IEq204.gif

41116_2023_36_Article_IEq54.gif