Prevalence of Concurrent Use of Prescribed Opioids and Benzodiazepine/Z-drugs and its Effect on Adverse Outcomes in Alberta

• Author / Creator

  Sharma, Vishal

• The opioid crisis has received much attention over the past few years in which prescribed opioids have been a significant contributor. In fact, Canada has among the highest rates of opioid prescribing in the world despite increasing recognition of the significant risks associated with such prescribing practices, including fatal overdose and dependency. Furthermore, individuals older than 65 years are especially prone to the consequences of prescribed opioids. As a result of this, clinical practice guidelines on the safe use and prescribing of opioids have been developed from a variety of sources and are acknowledged by health provider regulatory bodies across the country. A similar picture exists for benzodiazepines and Z-drugs (zopiclone, zolpidem), collectively known as benzodiazepine receptor modulators (BZDs). BZDs are widely prescribed psychotropic compounds for anxiety disorders and insomnia. Canadian clinical practice guidelines suggest that BZD treatment may be appropriate for short term use only in adults, and in some cases, as second line treatment. Use of BZDs outside of these recommendations is considered inappropriate because of the risk of adverse effects, especially in older adults.
  Within the opioid crisis, co-prescribing of opioids and BZDs represents a much less highlighted drug use pattern that is of substantial concern because of the higher risk of mortality. In fact, BZDs are implicated in up to 50% of opioid related deaths. Although there are no specific clinical guidelines on indications for co-prescribing of these medications, there are many recommendations warning against this practice. As such, safe drug use policies cannot target opioids and BZDs in isolation. Despite these warnings, co-prescribing of opioids and BZDs still occurs at alarming levels.
  The first objective of this research program was to expand the body of knowledge on co-prescribing by characterizing the prevalence of concurrent use of BZDs among opioid users using administrative data from Alberta in 2017. This was accomplished using a cross sectional approach in which the prevalence of concurrency was estimated among various sub-groups of patients. The results showed that the prevalence of concurrent use/co-prescribing of opioids and BZDs is higher among females, older adults and those with higher opioid doses and longer duration of opioid use. Higher healthcare utilization was also associated with a higher prevalence of concurrent use.
  
  The second objective was to quantify the added risk of concurrent BZD and opioid use compared to opioid only use. In this study, we used a case crossover method to compare the risk of hospitalization or emergency department (ED) visits and death between the concurrent population and opioid only population (reference group). Our results showed that concurrent use was associated with an increased risk of hospitalization, ED visits and death compared to opioid only use.
  In summary, our studies suggest that co-prescribing of opioids and BZDs occurs in Alberta at a substantial level, especially among certain sub-groups of the population and that this drug use pattern is also associated with a higher risk of adverse outcomes above that of opioid only use, an already high-risk group. These results suggest that the clinical warnings around co-prescribing of these agents may not be fully acknowledged by providers and that more education and monitoring may be needed.

• Subjects / Keywords

  • opioids
  • concurrent use
  • benzodiazepines
  • co-prescribing
  • death
  • outcomes

• Graduation date

  Spring 2020

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-b5af-9f88

• License

  Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.