Opioid and benzodiazepine prescription among patients with cirrhosis compared to other forms of chronic disease

Monica A. Konerman, Mary Rogers, Brooke Kenney, Amit Singal, Elliot Tapper, Pratima Sharma, Sameer Saini, Brahmajee Nallamothu, Akbar Waljee

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective Data on patterns and correlates of opioid and benzodiazepines prescriptions among patients with chronic conditions are limited. Given a diminished capacity for hepatic clearance, patients with cirrhosis represent a high risk group for use. The aim of this study was to characterise the patterns and correlates of prescription opioid, benzodiazepine and dual drug prescriptions among individuals with common chronic diseases. Design Analysis of Truven Marketscan database to evaluate individuals with drug coverage with cirrhosis (n=169,181), chronic hepatitis C without cirrhosis (n=210 191), congestive heart failure (n=766 840) or chronic obstructive pulmonary disease (n=1 438 798). Pharmacy files were examined for outpatient prescriptions. Results Patients with cirrhosis had a significantly higher prevalence of opioid prescriptions (37.1 per 100 person-years vs 24.3-26.0, p≤0.001) and benzodiazepine prescriptions (21.3 per 100 person-years vs 12.1-12.9, p<0.001). High dose opioid prescription (>90 daily oral morphine equivalents) (29.1% vs 14.4%, p<0.001) and dual opioid and benzodiazepine prescription (17.5% vs 9.6%-10.5 %, p<0.001) were also significantly more prevalent in cirrhosis. High dose opioid prescription was greater in men, individuals ages 40-59, in the Western USA, and among those with a mental health or substance abuse condition. Dual opioid and benzodiazepine prescription were highest among those with alcoholic cirrhosis and middle aged-adults. Conclusion Persons with cirrhosis have significantly higher rates of prescription opioid and benzodiazepine prescription compared to others with chronic diseases despite their high risk for adverse drug reactions. Demographics and mental health or substance abuse history can help identify high risk groups to target interventions.

Original languageEnglish (US)
Article numbere000271
JournalBMJ Open Gastroenterology
Volume6
Issue number1
DOIs
StatePublished - Apr 1 2019

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Benzodiazepines
Opioid Analgesics
Prescriptions
Fibrosis
Chronic Disease
Substance-Related Disorders
Mental Health
Drug Prescriptions
Alcoholic Liver Cirrhosis
Chronic Hepatitis C
Drug-Related Side Effects and Adverse Reactions
Chronic Obstructive Pulmonary Disease
Morphine
Outpatients
Heart Failure
Demography
Databases
Liver

Keywords

  • alcoholic liver disease
  • chronic liver disease
  • cirrhosis
  • hcv

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Opioid and benzodiazepine prescription among patients with cirrhosis compared to other forms of chronic disease. / Konerman, Monica A.; Rogers, Mary; Kenney, Brooke; Singal, Amit; Tapper, Elliot; Sharma, Pratima; Saini, Sameer; Nallamothu, Brahmajee; Waljee, Akbar.

In: BMJ Open Gastroenterology, Vol. 6, No. 1, e000271, 01.04.2019.

Research output: Contribution to journalArticle

Konerman, MA, Rogers, M, Kenney, B, Singal, A, Tapper, E, Sharma, P, Saini, S, Nallamothu, B & Waljee, A 2019, 'Opioid and benzodiazepine prescription among patients with cirrhosis compared to other forms of chronic disease', BMJ Open Gastroenterology, vol. 6, no. 1, e000271. https://doi.org/10.1136/bmjgast-2018-000271
Konerman, Monica A. ; Rogers, Mary ; Kenney, Brooke ; Singal, Amit ; Tapper, Elliot ; Sharma, Pratima ; Saini, Sameer ; Nallamothu, Brahmajee ; Waljee, Akbar. / Opioid and benzodiazepine prescription among patients with cirrhosis compared to other forms of chronic disease. In: BMJ Open Gastroenterology. 2019 ; Vol. 6, No. 1.
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abstract = "Objective Data on patterns and correlates of opioid and benzodiazepines prescriptions among patients with chronic conditions are limited. Given a diminished capacity for hepatic clearance, patients with cirrhosis represent a high risk group for use. The aim of this study was to characterise the patterns and correlates of prescription opioid, benzodiazepine and dual drug prescriptions among individuals with common chronic diseases. Design Analysis of Truven Marketscan database to evaluate individuals with drug coverage with cirrhosis (n=169,181), chronic hepatitis C without cirrhosis (n=210 191), congestive heart failure (n=766 840) or chronic obstructive pulmonary disease (n=1 438 798). Pharmacy files were examined for outpatient prescriptions. Results Patients with cirrhosis had a significantly higher prevalence of opioid prescriptions (37.1 per 100 person-years vs 24.3-26.0, p≤0.001) and benzodiazepine prescriptions (21.3 per 100 person-years vs 12.1-12.9, p<0.001). High dose opioid prescription (>90 daily oral morphine equivalents) (29.1{\%} vs 14.4{\%}, p<0.001) and dual opioid and benzodiazepine prescription (17.5{\%} vs 9.6{\%}-10.5 {\%}, p<0.001) were also significantly more prevalent in cirrhosis. High dose opioid prescription was greater in men, individuals ages 40-59, in the Western USA, and among those with a mental health or substance abuse condition. Dual opioid and benzodiazepine prescription were highest among those with alcoholic cirrhosis and middle aged-adults. Conclusion Persons with cirrhosis have significantly higher rates of prescription opioid and benzodiazepine prescription compared to others with chronic diseases despite their high risk for adverse drug reactions. Demographics and mental health or substance abuse history can help identify high risk groups to target interventions.",
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AU - Konerman, Monica A.

AU - Rogers, Mary

AU - Kenney, Brooke

AU - Singal, Amit

AU - Tapper, Elliot

AU - Sharma, Pratima

AU - Saini, Sameer

AU - Nallamothu, Brahmajee

AU - Waljee, Akbar

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N2 - Objective Data on patterns and correlates of opioid and benzodiazepines prescriptions among patients with chronic conditions are limited. Given a diminished capacity for hepatic clearance, patients with cirrhosis represent a high risk group for use. The aim of this study was to characterise the patterns and correlates of prescription opioid, benzodiazepine and dual drug prescriptions among individuals with common chronic diseases. Design Analysis of Truven Marketscan database to evaluate individuals with drug coverage with cirrhosis (n=169,181), chronic hepatitis C without cirrhosis (n=210 191), congestive heart failure (n=766 840) or chronic obstructive pulmonary disease (n=1 438 798). Pharmacy files were examined for outpatient prescriptions. Results Patients with cirrhosis had a significantly higher prevalence of opioid prescriptions (37.1 per 100 person-years vs 24.3-26.0, p≤0.001) and benzodiazepine prescriptions (21.3 per 100 person-years vs 12.1-12.9, p<0.001). High dose opioid prescription (>90 daily oral morphine equivalents) (29.1% vs 14.4%, p<0.001) and dual opioid and benzodiazepine prescription (17.5% vs 9.6%-10.5 %, p<0.001) were also significantly more prevalent in cirrhosis. High dose opioid prescription was greater in men, individuals ages 40-59, in the Western USA, and among those with a mental health or substance abuse condition. Dual opioid and benzodiazepine prescription were highest among those with alcoholic cirrhosis and middle aged-adults. Conclusion Persons with cirrhosis have significantly higher rates of prescription opioid and benzodiazepine prescription compared to others with chronic diseases despite their high risk for adverse drug reactions. Demographics and mental health or substance abuse history can help identify high risk groups to target interventions.

AB - Objective Data on patterns and correlates of opioid and benzodiazepines prescriptions among patients with chronic conditions are limited. Given a diminished capacity for hepatic clearance, patients with cirrhosis represent a high risk group for use. The aim of this study was to characterise the patterns and correlates of prescription opioid, benzodiazepine and dual drug prescriptions among individuals with common chronic diseases. Design Analysis of Truven Marketscan database to evaluate individuals with drug coverage with cirrhosis (n=169,181), chronic hepatitis C without cirrhosis (n=210 191), congestive heart failure (n=766 840) or chronic obstructive pulmonary disease (n=1 438 798). Pharmacy files were examined for outpatient prescriptions. Results Patients with cirrhosis had a significantly higher prevalence of opioid prescriptions (37.1 per 100 person-years vs 24.3-26.0, p≤0.001) and benzodiazepine prescriptions (21.3 per 100 person-years vs 12.1-12.9, p<0.001). High dose opioid prescription (>90 daily oral morphine equivalents) (29.1% vs 14.4%, p<0.001) and dual opioid and benzodiazepine prescription (17.5% vs 9.6%-10.5 %, p<0.001) were also significantly more prevalent in cirrhosis. High dose opioid prescription was greater in men, individuals ages 40-59, in the Western USA, and among those with a mental health or substance abuse condition. Dual opioid and benzodiazepine prescription were highest among those with alcoholic cirrhosis and middle aged-adults. Conclusion Persons with cirrhosis have significantly higher rates of prescription opioid and benzodiazepine prescription compared to others with chronic diseases despite their high risk for adverse drug reactions. Demographics and mental health or substance abuse history can help identify high risk groups to target interventions.

KW - alcoholic liver disease

KW - chronic liver disease

KW - cirrhosis

KW - hcv

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