Opioid analgesic and benzodiazepine prescribing among Medicaid-enrollees with opioid use disorders: The influence of provider communities

ABSTRACT

Opioid analgesic and benzodiazepine use in individuals with opioid use disorders can increase the risk for medical consequences and relapse. Little is known about rates of use of these medications or prescribing patterns among communities of prescribers. The goal of this study was to examine rates of prescribing to Medicaid-enrollees in the calendar year after an opioid use disorder diagnosis, and to examine individual, county, and provider community factors associated with such prescribing. 2008 Medicaid claims data were used from 12 states to identify enrollees diagnosed with opioid use disorders, and 2009 claims data were used to identify rates of prescribing of each drug. Social network analysis was used to identify provider communities, and multivariate regression analyses was used to to identify patient, county, and provider community level factors associated with prescribing these drugs. The authors also examined variation in rates of prescribing across provider communities. Among Medicaid-enrollees identified with an opioid use disorder, 45% filled a prescription for an opioid analgesic, 37% filled a prescription for a benzodiazepine, and 21% filled a prescription for both in the year following their diagnosis. Females, older individuals, individuals with pain syndromes, and individuals residing in counties with higher rates of poverty were more likely to fill prescriptions. Prescribing rates varied substantially across provider communities, with rates in the highest quartile of prescribing communities over 2.5 times the rates in the lowest prescribing communities. Prescribing opioid analgesics and benzodiazepines to individuals diagnosed with opioid use disorders may increase risk of relapse and overdose. Interventions should be considered that target provider communities with the highest rates of prescribing and individuals at the highest risk.

KEYWORDS:

• Opioid use disorders
• benzodiazepines
• opioids
• social network analysis
• prescribing behavior
• Medicaid

Acknowledgments

The authors are indebted to Mary Vaiana, PhD, for comments on a prior version of this manuscript, and Hilary Peterson, BA, both of the RAND Corporation, for research assistance and assistance with manuscript preparation.

Dr. Stein was previously an employee of Community Care Behavioral Health Organization, a non-profit managed behavioral health organization that managed behavioral health services of Medicaid-enrollees in Pennsylvania. Dr. Stein has also served on an Advisory Board for Otsuka Pharmaceuticals. Dr. Gordon receives royalties from Cambridge University Press and UptoDate for work unrelated to this topic. None of the other authors have any conflicts of interest to disclose.

Funding

The National Institute on Drug Abuse of the National Institutes of Health (NIH) provided support (award 1R01DA032881-01A1, PI: Stein and RO1AG043960-01, PI: Shih) for this study.