ASSOCIATION OF NEW PERIOPERATIVE BENZODIAZEPINE USE WITH PERSISTENT BENZODIAZEPINE USE
Main Article Content
Keywords
benzodiazepine, Frozen elephant trunk, Invaginated intimal mass
Abstract
Importance: Increased use of benzodiazepines has resulted in increasing rates of misuse and adverse effects associated with these drugs. Little is known about the initial exposure and source of benzodiazepines among those who use them persistently.
Objective: To examine the frequency of use and persistent use of benzodiazepines among patients undergoing major and minor surgical procedures.
Design, Setting, and Participants: This cohort study included 2 509 599 adult patients who underwent 1 of 11 common surgical procedures from 2009 to 2014 and were recorded in the MarketScan database. The rates of perioperative and persistent benzodiazepine use were examined in benzodiazepine-naive patients.
Results: Among 2 509 599 included patients, the mean (SD) age was 54.4 (15.3) years, and 1 596 137 (63.6%) were women. Perioperative benzodiazepine use was noted in 63 931 patients (2.6%). The median (interquartile range) benzodiazepine supply was 10 (5-23) days. Among benzodiazepine-naive patients prescribed a perioperative benzodiazepine, the rate of persistent benzodiazepine use was 19.5% (95% CI, 19.2%-19.8%). During the 90 to 180–day period after surgery, 7013 of 12 468 patients (56.2%) received 1 prescription for benzodiazepines while 5455 (43.8%) received 2 or more prescriptions. Among patients prescribed a benzodiazepine, persistent use was more common in Medicaid recipients (vs patients with commercial insurance: adjusted rate ratio [aRR], 1.29; 95% CI, 1.03-1.62), patients 70 years or older (vs those aged 40-49 years: aRR, 1.14; 95% CI, 1.05-1.23), in women (vs men: aRR, 1.10; 95% CI, 1.06-1.15), in patients with more medical comorbidities (eg, Elixhauser comorbidity score ≥3 vs 0: aRR, 1.11; 95% CI, 1.04-1.19), and in those with diagnoses of anxiety, depression, insomnia or substance use disorder (eg, with vs without anxiety: aRR, 1.43; 95% CI, 1.37-1.50).
Conclusions and Relevance: In this study, a relatively small percentage of surgical patients were prescribed benzodiazepines in the perioperative period; however, 1 in 5 of these patients went on to persistent benzodiazepine use.
References
2. Agarwal SD, Landon BE. Patterns in outpatient benzodiazepine prescribing in the United States. JAMA Netw Open. 2019;2(1):e187399. doi:10.1001/jamanetworkopen.2018.7399
ArticlePubMedGoogle Scholar
3. Maust DT, Lin LA, Blow FC. Benzodiazepine use and misuse among adults in the United States. Psychiatr Serv. 2019;70(2):97-106. doi:10.1176/appi.ps.201800321PubMedGoogle ScholarCrossref
4. Votaw VR, Geyer R, Rieselbach MM, McHugh RK. The epidemiology of benzodiazepine misuse: a systematic review. Drug Alcohol Depend. 2019;200:95-114. doi:10.1016/j.drugalcdep.2019.02.033PubMedGoogle ScholarCrossref
5. National Institute on Drug Abuse. Overdose death rates. Accessed September 16, 2020. https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
6. Johnson B, Streltzer J. Risks associated with long-term benzodiazepine use. Am Fam Physician. 2013;88(4):224-226.PubMedGoogle Scholar
7. Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952-1960. doi:10.1001/archinternmed.2009.357
ArticlePubMedGoogle ScholarCrossref
8. Stuck AE, Beers MH, Steiner A, Aronow HU, Rubenstein LZ, Beck JC. Inappropriate medication use in community-residing older persons. Arch Intern Med. 1994;154(19):2195-2200. doi:10.1001/archinte.1994.00420190095011
ArticlePubMedGoogle ScholarCrossref
9. McHugh RK, Peckham AD, Björgvinsson T, Korte FM, Beard C. Benzodiazepine misuse among adults receiving psychiatric treatment. J Psychiatr Res. 2020;128:33-37. doi:10.1016/j.jpsychires.2020.05.020PubMedGoogle ScholarCrossref
10. Brummett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504. doi:10.1001/jamasurg.2017.0504
ArticlePubMedGoogle Scholar
11. Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. 2014;348:g1251. doi:10.1136/bmj.g1251PubMedGoogle ScholarCrossref
12. IBM. IBM MarketScan research databases. Accessed April 21, 2021. https://www.ibm.com/watson-health/about/truven-health-analytics
13. Soneji N, Clarke HA, Ko DT, Wijeysundera DN. Risks of developing persistent opioid use after major surgery. JAMA Surg. 2016;151(11):1083-1084. doi:10.1001/jamasurg.2016.1681
ArticlePubMedGoogle ScholarCrossref
14. Benzodiazepine equivalency table. Accessed April 21, 2021. https://www.benzo.org.uk/bzequiv.htm
15. Marcusa DP, Mann RA, Cron DC, et al. Prescription opioid use among opioid-naive women undergoing immediate breast reconstruction. Plast Reconstr Surg. 2017;140(6):1081-1090. doi:10.1097/PRS.0000000000003832PubMedGoogle ScholarCrossref
16. Waljee JF, Zhong L, Hou H, Sears E, Brummett C, Chung KC. The use of opioid analgesics following common upper extremity surgical procedures: a national, population-based study. Plast Reconstr Surg. 2016;137(2):355e-364e. doi:10.1097/01.prs.0000475788.52446.7bPubMedGoogle ScholarCrossref
17. Harbaugh CM, Lee JS, Hu HM, et al. Persistent opioid use among pediatric patients after surgery. Pediatrics. 2018;141(1):141. doi:10.1542/peds.2017-2439PubMedGoogle ScholarCrossref
18. van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ. A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care. 2009;47(6):626-633. doi:10.1097/MLR.0b013e31819432e5PubMedGoogle ScholarCrossref
19. Wright JD, Huang Y, Melamed A, et al. Use and misuse of opioids after gynecologic surgical procedures. Obstet Gynecol. 2019;134(2):250-260. doi:10.1097/AOG.0000000000003358PubMedGoogle ScholarCrossref
20. Huang Y, Jacobson JS, Tergas AI, et al. Insurance-associated disparities in opioid use and misuse among patients undergoing gynecologic surgery for benign indications. Obstet Gynecol. 2020;136(3):565-575. doi:10.1097/AOG.0000000000003948PubMedGoogle ScholarCrossref
21. Larach DB, Waljee JF, Hu HM, et al. Patterns of initial opioid prescribing to opioid-naive patients. Ann Surg. 2020;271(2):290-295.PubMedGoogle ScholarCrossref
22. Boyd CJ, Austic E, Epstein-Ngo Q, Veliz PT, McCabe SE. A prospective study of adolescents’ nonmedical use of anxiolytic and sleep medication. Psychol Addict Behav. 2015;29(1):184-191. doi:10.1037/adb0000026PubMedGoogle ScholarCrossref
23. Fenton MC, Keyes KM, Martins SS, Hasin DS. The role of a prescription in anxiety medication use, abuse, and dependence. Am J Psychiatry. 2010;167(10):1247-1253. doi:10.1176/appi.ajp.2010.09081132PubMedGoogle ScholarCrossref
24. Austic E, McCabe SE, Stoddard SA, Ngo QE, Boyd C. Age and cohort patterns of medical and nonmedical use of controlled medication among adolescents. J Addict Med. 2015;9(5):376-382. doi:10.1097/ADM.0000000000000142PubMedGoogle ScholarCrossref
25. McLarnon ME, Monaghan TL, Stewart SH, Barrett SP. Drug misuse and diversion in adults prescribed anxiolytics and sedatives. Pharmacotherapy. 2011;31(3):262-272. doi:10.1592/phco.31.3.262PubMedGoogle ScholarCrossref
26. McCabe SE, West BT, Cranford JA, et al. Medical misuse of controlled medications among adolescents. Arch Pediatr Adolesc Med. 2011;165(8):729-735. doi:10.1001/archpediatrics.2011.114
ArticlePubMedGoogle ScholarCrossref
27. Substance Abuse and Mental Health Services Administration. Results from the 2017 National Survey on Drug Use and Health: detailed tables. Accessed October 15, 2015. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf
28. McCabe SE, West BT, Teter CJ, Boyd CJ. Trends in medical use, diversion, and nonmedical use of prescription medications among college students from 2003 to 2013: connecting the dots. Addict Behav. 2014;39(7):1176-1182. doi:10.1016/j.addbeh.2014.03.008PubMedGoogle ScholarCrossref
29. Inciardi JA, Surratt HL, Cicero TJ, et al. Prescription drugs purchased through the internet: who are the end users? Drug Alcohol Depend. 2010;110(1-2):21-29. doi:10.1016/j.drugalcdep.2010.01.015PubMedGoogle ScholarCrossref
30. Hwang CS, Kang EM, Kornegay CJ, Staffa JA, Jones CM, McAninch JK. Trends in the concomitant prescribing of opioids and benzodiazepines, 2002-2014. Am J Prev Med. 2016;51(2):151-160. doi:10.1016/j.amepre.2016.02.014PubMedGoogle ScholarCrossref
31. Sun EC, Dixit A, Humphreys K, Darnall BD, Baker LC, Mackey S. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ. 2017;356:j760. doi:10.1136/bmj.j760PubMedGoogle ScholarCrossref
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Dr. Anand Kumar
Associate Professor, Department Of General Surgery, IQ City Medical College, Durgapur