Concurrent Benzodiazepine and Opioid Prescriptions Increase the Risk for Long-term Opioid Use Among Patients With Low Back Pain

Heightened consideration of the risks associated with long-term opioid therapy have increased the need to understand factors that predict its use among individuals with low back pain (LBP). This retrospective study examined claims data from a single payer 2012–2015 to identify associations between early care decisions and long-term opioid use among opioid-naïve patients with a new physician consultation for LBP at which an opioid was prescribed. Long-term opioid use was defined as either >120 days of opioid medication, or >90 days with ≥10 opioid prescriptions filled, during 1-year follow-up. All included had a second claim for LBP during the year.

• Within 14 days of the index visit, the most common medications concurrently prescribed for LBP management were muscle relaxants (32%), NSAIDS (29%), oral steroids (12%), and benzodiazepines (8%).
• Within 30 days of the index visit, the most common early care provider visits included primary care (31%) and physical therapy (13%).
• 24% of study participants progressed to long-term opioid use.
• Controlling for patient factors, early concurrent benzodiazepine prescription and primary care visit was associated with an increased risk for long-term opioid use.
• Early physical therapy visit was associated with a reduced risk for long-term opioid use.

Comments: Although restricted to patients with at least 2 LBP visits, this study reinforces existing recommendations to avoid concurrent prescription of opioids and benzodiazepines among opioid-naïve patients presenting with LBP. It also highlights the important role that early physical therapy may have in reducing the risk for progression to long-term opioid use.

Seonaid Nolan, MD

Reference: Fritz JM, King JB, McAdams-Marx, C. Associations between early care decisions and the risk for long-term opioid use for patients with low back pain with a new physician consultation and initiation of opioid therapy. Clin J Pain. 2017;34:552–558.