Mental health and benzodiazepine use among patients on chronic opioid therapy

Abstract

Introduction: Higher daily doses of opioids as well as co-prescription of benzodiazepines have been associated with risk of overdose. The current study characterizes prescribing patterns in a family medicine practice with regard to patient mental health diagnoses, benzodiazepine prescriptions, morphine milligram equivalent opioid dose, and patient demographics. Methods: Patients on chronic opioid therapy were studied in 2018 and 2019. Mental health diagnoses, opioid dose, benzodiazepine prescriptions and demographic characteristics were extracted from the electronic health record. Data were compared between years and logistic regression was used to determine which patient characteristics were associated with likelihood of decreased opioid dose. Results: A total of 387 patients were prescribed chronic opioid therapy in 2018, and 231 in 2019. In 2018, 49.9% of patients prescribed chronic opioids had mental health diagnoses. In 2019, this proportion rose to 92.2%. In 2019, 205 of the original 387 patients were still with the practice but were not prescribed chronic opioids. Among the factors studied, psychiatric diagnosis and higher opioid dose were associated with a significantly lower likelihood of tapering doses. Discussion: As practices taper or de-prescribe opioids, or implement harm reduction methods such as de-prescribing benzodiazepines, it is important to understand patient characteristics and their relationship to success with tapering. This study adds to the evidence that odds of successfully tapering opioids may be significantly impacted by patients' mental health diagnosis and opioid dose.