title: Opioid analgesic and benzodiazepine prescribing among Medicaid-enrollees with opioid use disorders: The influence of provider communities.
abstract: Opioid analgesic and benzodiazepine use in individuals with opioid use disorders can increase the risk for medical consequences and relapse. Little is known about rates of use of these medications or prescribing patterns among communities of prescribers. The goal of this study was to examine rates of prescribing to Medicaid-enrollees in the calendar year after an opioid use disorder diagnosis, and to examine individual, county, and provider community factors associated with such prescribing. 2008 Medicaid claims data were used from 12 states to identify enrollees diagnosed with opioid use disorders, and 2009 claims data were used to identify rates of prescribing of each drug. Social network analysis was used to identify provider communities, and multivariate regression analyses was used to to identify patient, county, and provider community level factors associated with prescribing these drugs. The authors also examined variation in rates of prescribing across provider communities. Among Medicaid-enrollees identified with an opioid use disorder, 45% filled a prescription for an opioid analgesic, 37% filled a prescription for a benzodiazepine, and 21% filled a prescription for both in the year following their diagnosis. Females, older individuals, individuals with pain syndromes, and individuals residing in counties with higher rates of poverty were more likely to fill prescriptions. Prescribing rates varied substantially across provider communities, with rates in the highest quartile of prescribing communities over 2.5 times the rates in the lowest prescribing communities. Prescribing opioid analgesics and benzodiazepines to individuals diagnosed with opioid use disorders may increase risk of relapse and overdose. Interventions should be considered that target provider communities with the highest rates of prescribing and individuals at the highest risk.
authors.affiliation: a RAND Corporation , Pittsburgh , Pennsylvania , USA.|b University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Stein
authors.affiliation: c RAND Corporation , Santa Monica , California , USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Mendelsohn
authors.affiliation: b University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.|d Center for Health Equity Research and Promotion , VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.affiliation: e RAND Corporation , Boston , Massachusetts , USA.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
authors.affiliation: a RAND Corporation , Pittsburgh , Pennsylvania , USA.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Burns
authors.affiliation: a RAND Corporation , Pittsburgh , Pennsylvania , USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Sorbero
authors.affiliation: f RAND Corporation , Arlington , Virginia , USA.
authors.forename: Regina A
authors.initials: RA
authors.lastname: Shih
authors.affiliation: c RAND Corporation , Santa Monica , California , USA.
authors.forename: Rosalie
authors.initials: R
authors.lastname: Liccardo Pacula
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines
keywords: Medicaid; Opioid use disorders; benzodiazepines; opioids; prescribing behavior; social network analysis