PDG44 COPRESCRIBING OF OPIOIDS AND BENZODIAZEPINES IN TEXAS MEDICAID ENROLLEES

Unintentional prescription opioid overdoses and deaths have increased substantially in recent years with high rates occurring in Medicaid enrollees. The co-prescribing of opioids and benzodiazepines is associated with drug overdose deaths and although clinical guidelines caution against co-prescribing, several studies in Medicaid and non-Medicaid populations have reported a relatively high prevalence of co-prescribing of opioids and benzodiazepines. This study describes patient demographics and co-prescribing of opioids and benzodiazepines among Texas Medicaid enrollees and assesses the relationship between co-prescribing and demographic and utilization-related predictor variables This retrospective database analysis was conducted using de-identified Texas Medicaid prescription claims from July 2013 to June 2017. All patients aged 18 to 64 years at date of first opioid prescription claim were included in the study. Co-prescribing (overlapping opioid and benzodiazepine prescription for ≥14 days) was the dependent variable. Independent variables included age, gender, average prescribed daily dose, prescriber type, urban/rural status, number of months with any prescription claim, and public health region. Sensitivity analysis was conducted with co-prescribing defined as ≥3 days overlap. All analyses were conducted using SAS 9.4. Of the 328,113 identified opioid users, 35,792 (10.9%) had co-prescribing in year 1. Co-prescribing decreased slightly from 10.9% in year 1 to 9.2% in year 4. Older age, female gender, a higher number of total prescription claims, and a higher average daily prescribed dose were significantly associated with a higher likelihood of co-prescribing (p<0.0001). Primary care/internal medicine practice physicians were associated with a significantly higher likelihood of co-prescribing (p<0.01) compared to all other prescriber categories (except for anesthesiologists in year 1). Co-prescribing of opioids and benzodiazepines occurs among Texas Medicaid enrollees. Thus, strategies to foster appropriate prescribing to improve safety in opioid and benzodiazepine use should be considered.