title: Concomitant medication among persistent opioid users with chronic non-malignant pain.
abstract: BACKGROUND
  Recent guidelines for opioid treatment of chronic non-malignant pain discourage co-medication with benzodiazepines and benzodiazepine-related hypnotics, whereas co-medication with non-opioid analgesics and co-analgesics may offer a beneficial opioid sparing effect, and is recommended. The aim of this study was to describe 1-year periodic prevalence of co-medication with benzodiazepines, benzodiazepine-related hypnotics, non-opioid analgesics, co-analgesics and antidepressants in persistent opioid users with chronic non-malignant pain.
  
  
  METHODS
  The study is based on data from the Norwegian Prescription Database, covering all drugs dispensed to outpatients in 2008. Concomitant medication levels were compared between users in two definitions of persistent opioid use, all Norwegian adults dispensed opioids in 2008 and the Norwegian background population.
  
  
  RESULTS
  Of the Norwegian adult population studied, 1.2% met the criteria of persistent opioid use based on prescription pattern and prescription level. Sixty percent of persistent opioid users were dispensed a benzodiazepine or benzodiazepine-related hypnotic in amounts indicating regular use, with 15% dispensed a high amount of both classes. Sixty-two percent of persistent opioid users were dispensed one or more non-opioid analgesics, 47% an antidepressant and 33% were dispensed an antiepileptic drug.
  
  
  CONCLUSIONS
  Approximately 60% of persistent opioid users also receive benzodiazepines or benzodiazepine-related hypnotics in amounts indicating regular use. This is in conflict with recent guidelines for the treatment of chronic non-malignant pain and may indicate that these users are at an increased risk of developing problematic opioid use.
authors.affiliation: Department of Circulation and Medical Imaging, Pain and Palliation Research Group, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. andrm@stud.ntnu.no
authors.forename: A
authors.initials: A
authors.lastname: Mellbye
authors.forename: K
authors.initials: K
authors.lastname: Svendsen
authors.forename: P C
authors.initials: PC
authors.lastname: Borchgrevink
authors.forename: S
authors.initials: S
authors.lastname: Skurtveit
authors.forename: O M S
authors.initials: OM
authors.lastname: Fredheim
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D059350:Chronic Pain / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D016208:Databases, Factual; D004363:Drug Utilization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D009664:Norway / Q000453:epidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000929:Antidepressive Agents, Tricyclic; D001569:Benzodiazepines; D006993:Hypnotics and Sedatives; D017367:Selective Serotonin Reuptake Inhibitors