Coprescribing of Benzodiazepines and Opioids in Older Adults: Rates, Correlates, and National Trends

Abstract

Background: To estimate prescribing trends of and correlates independently associated with coprescribing of benzodiazepines and opioids among adults aged 65 years or older in office-based outpatient visits.

Methods: I examined a nationally representative sample of office-based physician visits by older adults between 2006 and 2015 (n = 109,149 unweighted) using data from the National Ambulatory Medical Care Surveys (NAMCS). National rates and prescribing trends were estimated. Then, I used multivariable logistic regression analyses to identify demographic and clinical factors associated with coprescriptions of benzodiazepines and opioids.

Results: From 2006 to 2015, 15,954 (14.6%) out of 109,149 visits, representative of 39.3 million visits nationally, listed benzodiazepine, opioid, or both medications prescribed. The rate of prescription benzodiazepines only increased monotonically from 4.8% in 2006-2007 to 6.2% in 2014-2015 (p < .001), and the rate of prescription opioids only increased monotonically from 5.9% in 2006-2007 to 10.0% in 2014-2015 (p < .001). The coprescribing rate of benzodiazepines and opioids increased over time from 1.1% in 2006-2007 to 2.7% in 2014-2015 (p < .001). Correlates independently associated with a higher likelihood of both benzodiazepine and opioid prescriptions included: female sex, a visit for chronic care, receipt of six or more concomitantly prescribed medications, and clinical diagnoses of anxiety and pain (p < .01 for all).

Conclusion: The coprescribing rate of benzodiazepines and opioids increased monotonically over time in outpatient care settings. Because couse of benzodiazepines and opioids is associated with medication burdens and potential harms, future research is needed to address medication safety in these vulnerable populations.

Keywords: Benzodiazepine; Older adults; Opioid; Outpatient care; Prescribing.