Patterns of Opioid and Benzodiazepine Use in Opioid-Naïve Patients With Newly Diagnosed Low Back and Lower Extremity Pain

Abstract

Abstract INTRODUCTION The morbidity and mortality associated with opioid and benzodiazepine co-prescribing is a pressing national concern. The aim of this work was to characterize patterns of opioid and benzodiazepine prescribing among opioid-naïve, newly-diagnosed low back and lower extremity pain patients and to investigate the relationship between benzodiazepine prescribing and long-term opioid use. METHODS We used a national database to identify adult patients newly diagnosed with low back pain (LBP) between 2008 and 2015 who did not have a red flag diagnosis, had not received an opioid prescription in the 6 mo prior to diagnosis, and had 12-mo of continuous enrollment after diagnosis. Among patients receiving at least 1 opioid prescription within 12 mo of diagnosis, we defined discrete patterns of benzodiazepine prescribing continued use, new use, stopped use, and never use. We tested the association of these prescription patterns with long-term opioid use, defined as 6or more fills within 12 mo. RESULTS We identified 2 497 653 opioid-naïve patients with newly diagnosed LBP or lower extremity pain. Between 2008 and 2015, 31.9% and 11.5% of these patients received opioid and benzodiazepine prescriptions, respectively, within 12 mo of diagnosis. Rates of opioid prescription decreased from 34.8% in 2008 to 27.0% in 2015; however, prescribing of benzodiazepines was unchanged (2008, 11.6%; 2015, 10.8%). Patients with continued or new benzodiazepine use consistently used more opioids than patients who never used or stopped using benzodiazepines during the study period (one-way ANOVA, P < .0001). For patients with continued and new benzodiazepine use, the odds ratio of long-term opioid use compared to those never prescribed a benzodiazepine was 2.99 (95% CI, 2.89-3.08) and 2.68 (95% CI, 2.62-2.75), respectively. CONCLUSION Overall opioid prescribing for LBP decreased substantially during the study period, indicating a shift in management within the medical community. Rates of benzodiazepine prescribing, however, remained unchanged. Patterns of benzodiazepine prescribing were associated with long-term opioid use.