Co-prescription of opioids with benzodiazepine and other co-medications among opioid users: differential in opioid doses

Abstract

Purpose

This study investigated the patterns of opioid co-prescription with benzodiazepine and other concomitant medications among opioid users. Opioid dose in each type of co-prescription was also examined.

Patients and methods

This cross-sectional study was conducted among opioid users receiving concomitant medications at an outpatient tertiary hospital setting in Malaysia. Opioid prescriptions (morphine, fentanyl, oxycodone, dihydrocodeine and tramadol) that were co-prescribed with other medications (opioid + benzodiazepines, opioid + antidepressants, opioid + anticonvulsants, opioid + antipsychotics and opioid + hypnotics) dispensed from January 2013 to December 2014 were identified. The number of patients, number of co-prescriptions and the individual mean opioid daily dose in each type of co-prescription were calculated.

Results

A total of 276 patients receiving 1059 co-prescription opioids with benzodiazepine and other co-medications were identified during the study period. Of these, 12.3% of patients received co-prescriptions of opioid + benzodiazepine, 19.3% received opioid + anticonvulsant, 6.3% received opioid + antidepressant and 10.9% received other co-prescriptions, including antipsychotics and hypnotics. The individual mean opioid dose was <100 mg/d of morphine equivalents in all types of co-prescriptions, and the dose ranged from 31 to 66 mg/d in the co-prescriptions of opioid + benzodiazepine.

Conclusion

Among the opioid users receiving concomitant medications, the co-prescriptions of opioid with benzodiazepine were prescribed to 12.3% of patients, and the individual opioid dose in this co-prescription was moderate. Other co-medications were also commonly used, and their opioid doses were within the recommended dose. Future studies are warranted to evaluate the adverse effect and clinical outcomes of the co-medications particularly in long-term opioid users with chronic non-cancer pain.

Keywords:

• co-prescription
• opioid
• benzodiazepine
• co-medication
• opioid users
• pain

Acknowledgments

CSZ was supported by research grants from The International Islamic University Malaysia (Endowment B-EDW 14-095-0980) and The Ministry of Education Malaysia (Fundamental Research Grant Scheme-FRGS 14-195-0436).

Author contributions

CSZ initiated and developed the research questions and study design, conducted data management and analysis and drafted the manuscript. All the authors contributed to the data acquisition and interpretation of the data, critically revised the manuscript and approved the final version submitted for publication.

Disclosure

The authors report no conflicts of interest in this work.