Rates of Opioid Use Disorder With Gabapentin, Benzodiazepine Coprescription Evaluated
Opioid use disorder risk was higher in a cohort of patients with chronic pain without disability.
Coprescription of opioid therapies with either gabapentin or benzodiazepines for crhonic pain can substantially increase an individual’s risk of opioid use disorder, according to research published in the American Journal of Preventive Medicine.1
Coprescription of opioids, benzodiazepines, and gapapentinoids can increase the risk of developing opioid use disorder. | Image credit: Aleksej - stock.adobe.com
Using Medicaid data from 2016-2019, researchers analyzed 2 chronic pain subgroups within a cohort of patients between 35 and 64 years of age from 25 US states. Cohort 1 included patients with chronic pain and physical disability (n=6133), and cohort 2 included patients with chronic pain without disability (n=67,438). The primary study outcome was opioid use disorder.
Both subgroups were demographically similar; however, a higher prevalence of mental health disorders in was noted in cohort 1. More than half of those with chronic pain and physical disability (61%) received an opioid prescription, compared with 40% of those with chronic pain without disability. Both subgroups were commonly coprescribed benzodiazepines, gabapentinoids, and muscle relaxants, and one-quarter of patients in either subgroup had a claim for physical therapy.
Among those with chronic pain and no disability, coprescription of opioids and gabapentin was associated with a 45% increase in opioid use disorder risk (95% CI, 19%-77%), while coprescription of opioids and benzodiazepines was associated with a 37% increase in opioid use disorder risk (95% CI, 12%-67). Increases in the proportion of days covered by an opioid and increases in opioid dose were also statistically significantly associated with small increased risks of opioid use disorder.
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Conversely, physical therapy was associated with a decreased opioid use disorder risk; in the chronic pain without disability cohort, the association was statistically significant: an 18% decreased risk (95% CI, 5%-30%).
“This study found statistically robust evidence of which pain treatments were associated with the most [opioid use disorder] risk and which were associated with reduced risk,” the researchers wrote, adding that point estimates were “generally in the same direction” for both subgroups. However, when focusing on the subgroup of individuals with chronic pain without disability, “this study’s findings raise concerns about the coprescription of opioids with gabapentin or benzodiazepines, which have become mainstays of pain treatment.”
Study limitations include the use of claims data, which may be inaccurately or incompletely recorded, a lack of information on “several potentially important confounding variables” that Medicaid data lack, and limited sociodemographic variables of beneficiaries, among other limitations.
“Findings support the need for prescribing guidelines to make clinicians aware of the potential risks associated with coprescribing gabapentin or benzodiazepines with opioids and to encourage the use of physical therapy to treat chronic pain,” the researchers concluded.
READ MORE: Pain Management Resource Center
