Prescribing Patterns of High Opioid Doses and Concurrent Medications in Medicare-Eligible Adults

Researchers from the Institute of Therapeutic Innovations and Outcomes at The Ohio State University College of Pharmacy, led by A. Silva Almodovar, felt there was a lack of available data on the prescribing patterns of medications among Medicare eligible adults at risk for opioid overdoses. They conducted a retrospective study assessing morphine milligram equivalent (MME) doses, and they found that “nearly one-fourth of patients were prescribed a daily MME ≥50.” Notably, these patients were “more likely to use [tricyclic antidepressants (TCAs)], [skeletal muscle relaxants (SMR)], or hypnotics, which have been associated with adverse events among adults at risk for opioid overdose.”

The study’s poster, presented at AMCP 2022, also reported that although naloxone is recommended to be coprescribed in patients with chronic opioid use to reduce mortality and emergency room visits, it “was under prescribed among eligible adults.”

The study analysis separated a total of 4,568 patients based on daily MME thresholds of fewer than 50 (n = 3,452) and 50 or greater (n = 1,116). Medications compared between the cohorts included benzodiazepines, SMRs, hypnotics, GABA analogs, selective-serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRIs), TCAs, antipsychotics, and naloxone.

According to Almodovar and colleagues, patients with a daily MME ≥50 were more likely to be prescribed SMRs (odds ratio [OR] = 1.43; 95% confidence interval [CI], 1.22–1.68), hypnotics (OR = 1.74; 95% CI, 1.45–2.09), SNRIs (OR = 1.35; 95% CI, 1.14–1.59), or TCAs (OR = 1.61; 95% CI, 1.25–2.07), and naloxone (OR = 2.97; 95% CI, 1.36–3.73). Notably, 11% of eligible patients received a naloxone prescription. Finally, the researchers found that patients younger than 85 were at 1.58 to 4.04 times the odds of being prescribed a daily MME ≥50 compared with individuals older than 85 (p ≤0.004).

Given their results, the study’s authors ultimately proposed that “implementation of targeted services should be considered to assess prescribing among patients with chronic opioid therapies.”