Opioid-Benzodiazepine Coprescribing Continues, Majority in Primary Care

January 30, 2020

Over half of coprescriptions were among general or family practice physicians and 40% among internal medicine physicians, a new CDC report suggests. 

More than 50% of US physician office visits at which benzodiazepines and opioids are coprescribed occur in a primary care clinic, a new National Health Statistics Report found.

Prescribing benzodiazepines with opioids can increase a patient’s risk of respiratory depression, which is why in 2016 the US Food and Drug Administration issued a safety announcement warning against the use of opioids by patients taking prescription benzodiazepines.

Despite this, “a recent trend analysis using data from the National Ambulatory Medical Care Survey (NAMCS) showed that coprescription of benzodiazepines and opioids increased from 0.5% of physician office visits in 2003 to 2.0% in 2015,” said authors in the report. “In 2015, opioids were prescribed at 26.4% of visits at which there was also a benzodiazepine prescription.”

To examine the characteristics of office-based physician visits where benzodiazepines are prescribed as well as visits that involve overlapping opioid prescriptions, researchers used data from the 2014-2016 NAMCS.

Primary care physicians are the biggest culprit

Between 2014 and 2016, benzodiazepines were prescribed at approximately 65.9 million office-based physician visits and 35% of those visits (23 million) involved overlapping opioid prescriptions.

Out of the 23 million office-based physician visits where benzodiazepines and opioids were coprescribed, 56% were with a primary care physician vs 42% of visits were with nonprimary care providers.

Among primary care physicians, general or family practice was the most frequent specialty for visits (55%) at which benzodiazepines were prescribed with opioids, followed by internal medicine (40%).

In office-based physician visits where only benzodiazepines were prescribed, 48% were with a primary care physician and 50% were with a nonprimary care physician. Among primary care physicians, 54% of visits were with a general or family physician and 39% were with an internal medicine physician.

Additional characteristics of visits at which benzodiazepines were coprescribed with opioids:

  • Physician office visit rate: 10 visits/100 adults

  • Overall, visit rates were higher for women (11 visits/100 women) vs men (8 visits/100 men)

  • Visit rates increased with age: 4 visits/100 adults aged 18-44 years, 13 visits/100 adults aged 45-64 years, and 16 visits/100 adults aged ≥65 years.

  • Percentage of visits having new coprescription of benzodiazepines and opioids was lower vs percentage of visits with continued coprescription across all age groups.

  • Disease of the musculoskeletal system and connective tissue was the most frequent primary diagnosis category for visits (22%).

  • Problem related to chronic condition was the most frequent reason for visits (57%), followed by a new problem (23%).

Analyzing office-based physician visits may help monitor both benzodiazepine prescriptions and coprescriptions with opioids, the researchers concluded.

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