Patterns of opioid and benzodiazepine use with gabapentin among disabled Medicare beneficiaries - A retrospective cohort study.

Autor: Olopoenia A; University of Maryland, Baltimore, Department of Pharmaceutical Health Services Research, 220N. Arch St., Baltimore, MD 21201, United States. Electronic address: aolopoenia@umaryland.edu., Camelo-Castillo W; University of Maryland, Baltimore, Department of Pharmaceutical Health Services Research, 220N. Arch St., Baltimore, MD 21201, United States. Electronic address: wcastillo@rx.umaryland.edu., Qato DM; University of Maryland, Baltimore, Department of Pharmaceutical Health Services Research, 220N. Arch St., Baltimore, MD 21201, United States; University of Maryland, Baltimore, School of Medicine, 655W. Baltimore St, Baltimore, MD 21201, United States. Electronic address: dqato@rx.umaryland.edu., Adekoya A; Johns Hopkins Medicine, Department of Anesthesiology & Critical Care Medicine, Division of Chronic Pain Medicine, United States. Electronic address: padekoy3@jhmi.edu., Palumbo F; University of Maryland, Baltimore, Department of Pharmaceutical Health Services Research, 220N. Arch St., Baltimore, MD 21201, United States. Electronic address: fpalumbo@rx.umaryland.edu., Sera L; University of Maryland, Baltimore, Department of Pharmacy Practice and Science, United States. Electronic address: lsera@rx.umaryland.edu., Simoni-Wastila L; University of Maryland, Baltimore, Department of Pharmaceutical Health Services Research, 220N. Arch St., Baltimore, MD 21201, United States; Peter Lamy Center on Drug Therapy and Aging, University of Maryland Baltimore, Baltimore, United States. Electronic address: lsimoniw@rx.umaryland.edu.
Jazyk: angličtina
Zdroj: Drug and alcohol dependence [Drug Alcohol Depend] 2022 Jan 01; Vol. 230, pp. 109180. Date of Electronic Publication: 2021 Nov 17.
DOI: 10.1016/j.drugalcdep.2021.109180
Abstrakt: Background: Our goal was to describe specific patterns associated with co-prescriptions of gabapentin, opioids, and benzodiazepines among disabled Medicare beneficiaries.
Methods: Using 2013-2015 Medicare data, we conducted a retrospective cohort study among fee-for-service disabled beneficiaries continuously enrolled in Medicare Parts A, B, and D. The index date was defined as the earliest fill date for a gabapentin, opioid, or benzodiazepine prescription. Monotherapy, dual therapy, and tri-therapy were defined as utilization of one, two, and three medication classes, respectively. Augmentation was defined as a prescription for a different medication class in addition to prescription for initial medication; switching referred to a change in prescription for a different medication class with no subsequent fills of initial medication. We used descriptive statistics, Kaplan Meier analyses and Cox proportional hazards to examine the association between initial therapy and monotherapy, dual therapy, tri-therapy, switching and augmentation.
Results: Among 151,552 disabled beneficiaries, gabapentin initiators were more likely to augment therapy (50.1%) when compared to opioid (28.7%) and benzodiazepine (38.7%) users. When compared to opioid initiators, the risk of augmentation (HR[95%CI]: 1.85[1.82-1.89]) and switching (1.62 [1.51-1.73]) was significantly higher among gabapentin initiators. Risk of augmentation was also significantly higher among beneficiaries with co-morbid pain and mental health conditions (p < 0.01). Overall, the majority of beneficiaries augmented and switched within 2-months and 4-months after initiating therapy, respectively.
Conclusions: Given safety concerns associated with gabapentin, opioids, and benzodiazepines, it is imperative that the benefits and risks of co-prescribing these medications be examined comprehensively, especially for those in vulnerable sub-groups.
(Copyright © 2021 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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