title: Urine specimen detection of zolpidem use in patients with pain.
abstract: This study examined zolpidem and concurrent opioid, benzodiazepine, other central nervous system (CNS) depressants, and alcohol use. Urine specimens were analyzed using liquid chromatography-mass spectrometry (LC-MS/MS). Specimens were tested for zolpidem (n = 71,919) and separated into a provider-reported medication list documenting (n = 5,257) or not documenting zolpidem use (n = 66,662). Zolpidem-positive specimens were further separated into reported and unreported use cohorts. The total number of zolpidem-positive specimens in the reported and unreported use cohorts was 3,391 and 3,190, respectively. Non-informed prescribers were 4.4% (3,190/71,919) among the general population and 48.5% (3,190/6,581) when only zolpidem users were considered. In the zolpidem user population, the most common concurrent opioids in both cohorts were hydrocodone and oxycodone. Alprazolam and clonazepam were higher in the unreported use cohort (P ≤ 0.05). The unreported use cohort also had a higher detection of zolpidem plus a benzodiazepine (49.7 vs. 46%; P ≤ 0.05), zolpidem plus an opioid and a benzodiazepine (40.8% vs. 37.4%; P ≤ 0.05) and zolpidem plus an opioid, a benzodiazepine, and an other CNS depressant (12.9 vs. 10.9%; P ≤ 0.05). Concurrent use of zolpidem, an opioid, a benzodiazepine and an other CNS depressant is prevalent in a pain patient population.
authors.affiliation: University of California, San Diego (UCSD), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA.
authors.forename: Lindsey M
authors.initials: LM
authors.lastname: Mann
authors.affiliation: University of California, San Diego (UCSD), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA Doris A. Howell Palliative Care Services, San Diego, CA, USA.
authors.forename: Rabia S
authors.initials: RS
authors.lastname: Atayee
authors.affiliation: University of California, San Diego (UCSD), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA UCSD Department of Pediatrics, Rady's Children's Hospital, San Diego, CA, USA.
authors.forename: Brookie M
authors.initials: BM
authors.lastname: Best
authors.affiliation: University of California, San Diego (UCSD), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA Diabetes Intense Medical Management Clinic, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA.
authors.forename: Candis M
authors.initials: CM
authors.lastname: Morello
authors.affiliation: University of California, San Diego (UCSD), Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA Doris A. Howell Palliative Care Services, San Diego, CA, USA joema@ucsd.edu.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Ma
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use / Q000652:urine*; D002853:Chromatography, Liquid; D015331:Cohort Studies; D004347:Drug Interactions; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use / Q000652:urine*; D057230:Limit of Detection; D010146:Pain / Q000188:drug therapy / Q000652:urine*; D011725:Pyridines / Q000627:therapeutic use / Q000652:urine*; D012189:Retrospective Studies; D053719:Tandem Mass Spectrometry; D000077334:Zolpidem
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem