Benzodiazepine Prescription Associated with Early Opioid Refills in Patients Receiving Long-Term Opioid Therapy

Benzodiazepines are often prescribed to patients receiving opioids for chronic pain. Although concurrent receipt of benzodiazepines and opioids is associated with increased risk of adverse outcomes such as fatal and nonfatal opioid overdose, less is known about the association of benzodiazepines with aberrant drug-related behavior in this patient population. In this study, researchers retrospectively evaluated the medical records of 847 primary care patients receiving long-term opioid therapy (3+ prescriptions 21+ days apart within 6 months) who had at least 1 urine drug screen over 1 year. The aberrant drug-related behavior outcomes were ≥ 2 early opioid refills (prescription for same opioid within 7–25 days of the prior prescription) and positive urine cocaine screen.

• 196 (23%) patients received ≥ 1 benzodiazepine prescriptions. Patients receiving benzodiazepines were more likely to be white, female, and to have headache, depression, and anxiety.
• 183 (22%) patients had ≥ 2 early opioid refills and 93 (11%) had ≥ 1 positive urine cocaine screens. Eighty percent of early opioid refills lacked prescriber documentation of the reason for early refill.
• In adjusted analyses, receipt of a benzodiazepine prescription was associated with increased risk of early opioid refills (hazard ratio, 1.54) but not associated with a positive urine cocaine screen (odds ratio, 1.07).

Comments:

The increased risk of receiving early opioid refills may indicate addictive behavior, severe pain, or lower pain tolerance among patients receiving a benzodiazepine prescription. However, the reason for early opioid refills cannot be discerned from this study. The results add to the growing literature on the increased risks of concurrent receipt of benzodiazepine and opioid medications. For their patients receiving opioid therapy for chronic pain, providers should consider alternative therapies to benzodiazepines.

Kevin L. Kraemer, MD, MSc

Reference:

Park TW, Saitz R, Nelson KP, et al. The association between benzodiazepine prescription and aberrant drug-related behaviors in primary care patients receiving opioids for chronic pain. Subst Abuse. 2016 [Epub ahead of print]. doi: 10.1080/08897077.2016.1179242.