Overlapping prescriptions of opioids, benzodiazepines, and carisoprodol: "Holy Trinity" prescribing in the state of Florida.
Adolescent
Adult
Aged
Analgesics, Opioid
/ administration & dosage
Benzodiazepines
/ administration & dosage
Carisoprodol
/ administration & dosage
Drug Overdose
/ epidemiology
Drug Prescriptions
/ standards
Drug Therapy, Combination
Female
Florida
/ epidemiology
Humans
Male
Middle Aged
Muscle Relaxants, Central
/ administration & dosage
Pain
/ drug therapy
Practice Patterns, Physicians'
/ standards
Prescription Drug Monitoring Programs
/ standards
Young Adult
Benzodiazepine
Carisoprodol
Inappropriate prescribing
Opioid
Prescription drug monitoring program
Journal
Drug and alcohol dependence
ISSN: 1879-0046
Titre abrégé: Drug Alcohol Depend
Pays: Ireland
ID NLM: 7513587
Informations de publication
Date de publication:
01 12 2019
01 12 2019
Historique:
received:
27
04
2019
revised:
18
09
2019
accepted:
21
09
2019
pubmed:
22
11
2019
medline:
24
6
2020
entrez:
22
11
2019
Statut:
ppublish
Résumé
High-risk combinations of controlled medications, such as those involving opioid analgesics, are under increased scrutiny because of their contribution to the opioid epidemic in the United States. Responsible prescribing guidelines indicate that the triple drug combination--opioids, benzodiazepines and skeletal muscle relaxants, especially carisoprodol--should not be concurrently prescribed. This pharmacoepidemiologic study was designed to primarily examine the characteristics of patients receiving this triple combination compared to the group receiving only opioids and benzodiazepines. Results show that, while the number of exposed patients has declined since 2012, approximately 17,000 Floridians were prescribed this combination in 2017 alone. Demographically, recipients of these prescriptions were younger, more likely to be female, and geographically-localized. Furthermore, these patients were more frequently associated with a prescriber in the top 1% of opioid and/or benzodiazepine prescribing, have more multiple provider episodes ("doctor shopping"), and receive higher mean daily opioid dosages. These findings raise important questions as to how frequently prescribers are checking prescription drug monitoring programs, following US Centers for Disease Control and Prevention opioid prescribing guidelines, and/or handling the clinical challenges associated with pharmaceutical management of patients with complex, painful health conditions.
Sections du résumé
BACKGROUND
High-risk combinations of controlled medications, such as those involving opioid analgesics, are under increased scrutiny because of their contribution to the opioid epidemic in the United States. Responsible prescribing guidelines indicate that the triple drug combination--opioids, benzodiazepines and skeletal muscle relaxants, especially carisoprodol--should not be concurrently prescribed.
METHODS
This pharmacoepidemiologic study was designed to primarily examine the characteristics of patients receiving this triple combination compared to the group receiving only opioids and benzodiazepines.
RESULTS
Results show that, while the number of exposed patients has declined since 2012, approximately 17,000 Floridians were prescribed this combination in 2017 alone. Demographically, recipients of these prescriptions were younger, more likely to be female, and geographically-localized. Furthermore, these patients were more frequently associated with a prescriber in the top 1% of opioid and/or benzodiazepine prescribing, have more multiple provider episodes ("doctor shopping"), and receive higher mean daily opioid dosages.
CONCLUSIONS
These findings raise important questions as to how frequently prescribers are checking prescription drug monitoring programs, following US Centers for Disease Control and Prevention opioid prescribing guidelines, and/or handling the clinical challenges associated with pharmaceutical management of patients with complex, painful health conditions.
Identifiants
pubmed: 31751873
pii: S0376-8716(19)30470-3
doi: 10.1016/j.drugalcdep.2019.107693
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Muscle Relaxants, Central
0
Benzodiazepines
12794-10-4
Carisoprodol
21925K482H
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
107693Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.