Opioids, Benzodiazepines Used Concurrently Despite FDA Warning

Pharmacist outreach may reduce opioid prescriptions.

Opioid misuse disorder is widespread through the United States, and has caused many deaths in the past few years. Federal and state governments are implementing numerous initiatives to reduce opioid use and increase access to treatment.

Two new studies conducted by pharmacy benefit manager Prime Therapeutics illustrate the use of novel strategies to increase education about safe drug use in an effort to combat the opioid epidemic, according to a press release. The results will be discussed at the Academy of Managed Care Pharmacy’s 2017 Annual Meeting.

The first study examined the concurrent use of opioids with benzodiazepines, which the FDA recently developed stricter guidelines for due to the dangerous nature of the drug combination. Other research shows that the use of opioids and benzodiazepines can increase the risk of overdose and death.

Included in the study were integrated pharmacy and medical claims for 15 million members from 2015. The researchers found that 3.7 million adult patients had 1 or more opioid or benzodiazepine claim, according to the press release.

Of those patients, 884,407 members had 2 or more opioid claims, while 234,996 members had 2 or more benzodiazepine claims.

After excluding those with cancer, 132,308 of the 777,035 members with opioid claims were concurrently using benzodiazepine for 30 days or more. Approximately 1 in 1000 commercially insured Prime members — or 1 in 6 opioid users without cancer – used both drugs for 30 days or more in 2015, according to the study.

Due to these findings, it is clear that additional efforts are needed to educate prescribers and patients about the dangers of concurrent use of opioids and benzodiazepines.

“We found nine per 1,000 (0.9 percent) of Prime’s entire commercially insured population were currently using an opioid and benzodiazepine. This means an alarming number of individuals are using the combination, placing themselves at increased risk,” said Cathy Starner, PharmD, principal health outcomes researcher at Prime. “The Pharmacy Quality Alliance, a nonprofit organization representing stakeholders interested in improving the quality of the medication-use system, recently endorsed the ‘Concurrent Use of Opioids and Benzodiazepines’ pharmacy quality metric. Health plans need to put steps in place to identify these members early and intervene, to ensure they are taking these medications safely.”

In the second study, Prime discovered that pharmacists based in a pharmacy benefit manager or health plan who reached out to prescribers were able to reduce emergency department use and costs among controlled substance users.

Included in the study were 213 Prime members who were taking controlled substances and a control group of 1387 members. A letter and telephone call were received by providers who prescribed the drugs to discuss treatment regimens, according to the release. The designated pharmacists then suggested changes that could improve patient safety.

After the outreach, the cost of controlled substances were observed to decrease from $5802 to $5148 per member in the intervention group. However, in the control group, costs for controlled substances increased from $3511 to $3627 per member.

Patients in the intervention group were 6.4% less likely to visit the emergency department compared with the control group, according to the release.

These findings suggest that outreach from pharmacists may cause physicians to re-evaluate their prescribing practices in a beneficial way.

“Over a 1-year period, managed care pharmacist to prescriber outreach led to fewer emergency room visits and lower controlled substance drug costs among members using controlled substances,” Starner concluded. “Opioid abuse and misuse has become a leading cause of death in this country, claiming thousands of lives each year. It’s critical that controlled substances are used appropriately for members who need them and this study shows managed care pharmacists can play an important role.”