PDG52 CONCOMITANT USE OF OPIOIDS AND CENTRAL NERVOUS SYSTEM DEPRESSANTS IN PATIENTS WITH NONMALIGNANT CHRONIC PAIN AND ADHERENCE TO FOOD AND DRUG ADMINISTRATION WARNING

Abstract

The FDA warns about serious risks and death when combining opioids and CNS depressants. These agents have synergistic effects and increase risk of overdose. We assessed concomitant use of opioids and CNS depressants in non-malignant chronic pain(NMCP) patients using current real-world data. Factors associated with combined use of opioid and CNS depressants were determined. This cross-sectional study used CDC provided National Ambulatory Medical Care Survey(NAMCS) data from 2006-2016. Visits were selected based on reason for visit and diagnoses related to NMCP. Factors associated with concomitant use of opioids and CNS depressants were determined using logistic regression. A total of 111,201,063 weighted and 4591 non-weighted visits with NMCP were observed with 60% female and 85% White and mean age of 52 years(±15.04). Of the total sample, 41%(n: 45,378,017) had at least one opioid. About 18%(n:19,906,406) visits with CNS depressants; among them, concomitant use of opioids and CNS depressants was observed in 57%(n:11,34,651). Patients with opioids were 1.9 times [odds ratio(OR):1.94,95%(CI):1.64-2.29] more likely to receive a CNS depressant compared to patients without an opioid medication. Visits with PCP were twice as likely [OR:2.08,95%CI:1.83-2.36] to have opioids and CNS depressants than non-PCP visits. Patients on five or more medications were 3.9 times [OR:3.86,95%CI:3.39-4.40] more likely to have opioid and CNS depressants compared to patients on less than five medications. Despite FDA warnings, alarming percent of patients were on both opioids and CNS depressants. Even though, multiple studies have shown risks of overdose and death increase significantly with concomitant use of opioids and CNS depressants, it is evident from our findings that evidence-based medicine was not fully adhered to. Additional training and reinforcement of FDA warnings may promote for safer care for NMCP patients.