(081) Patterns of Concurrent Opioid and Benzodiazepine Use Discontinuation among Medicare Beneficiaries 2016-2018

Background: Long-term concurrent use of opioids and benzodiazepines (COB) can lead to adverse outcomes such as falls, addiction, and overdose. While tapering one or both medications can mitigate these risks, abrupt discontinuation can result in unintended consequences. The 2022 Centers for Disease Control and Prevention opioid guideline highlights the importance of evaluating the risk-benefit of concurrent use and planning the sequential order of tapering based on individual patients’ chronic disease conditions and treatment needs.

Objectives: This study aims to examine patterns of concurrent opioid and benzodiazepine use discontinuation among Medicare beneficiaries.

Methods: We conducted a retrospective descriptive study using Medicare fee-for-service (FFS) claims data from 2016 to 2018. We identified beneficiaries aged 18 years or older with continuous FFS and Part D enrollment who were not in hospice during the study period. Opioid and benzodiazepine prescriptions were identified using National Drug Codes from the outpatient pharmacy claims. The supply duration was extended to account for the pre-existing stockpile of the same medication. We defined COB discontinuation as a gap greater than 90 days between overlapping episodes and categorized the episodes as both medications discontinued, opioids stopped first, and benzodiazepine stopped first.

Results: We analyzed data from 3,412,490 eligible Medicare beneficiaries, of whom 58.9% were female and 16.0% had a history of cancer. During the study period, 49.1% (1,673,838) of patients had at least one opioid prescription, and 25.0% (852,100) had at least one benzodiazepine prescription. We identified 360,484 patients (10.6%) with at least one day of overlapping opioid/benzodiazepine prescription, resulting in 2,068,536 COB episodes. Among these patients, 34.5% had only one episode, 13.8% had two, and 8.2% had three episodes. The quartiles of COB episode length were 8, 20, and 30 days, respectively, and the median time between episodes (or the end of 2018) was 12 days (interquartile range: 32). After excluding the episodes without enough look-forward period, we identified 295,817 concurrent users experiencing discontinuation. Of 434,347 discontinued COB episodes, 40% stopped opioids first, 26% stopped benzodiazepines first, and 34% stopped both simultaneously. This represented 42%, 30%, and 42% of COB users who encountered discontinuation.

Conclusions: Our study provides real-world evidence on the sequential discontinuation order among concurrent-use patients. Future research is needed to understand the optimal dose reduction patterns and associated outcomes, which can inform clinical decision-making regarding tapering strategies and ultimately reduce the harm associated with COB use.