Prescribing Practices Related to Concomitant Opioid and Benzodiazepine Use: A Focus Group

Purpose: The Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) have issued warnings against the co-prescribing of benzodiazepines and opioids due to increased risk of drug overdose. Despite these warnings, benzodiazepines remain commonly prescribed with opioid containing products. The factors behind this practice are not well described. The objectives of this study were to evaluate provider perceptions in the following areas related to concomitant opioid and benzodiazepine use: prescribing practices, mitigation of patient risks, and issues not addressed by other agencies. Methods: This study was approved by the University of North Texas (UNT) Health Science Center in November 2017. Focus groups were conducted among providers at UNT Health clinics in Fort Worth, TX, to elicit opinions related to the co-prescribing of opioids and benzodiazepines. The study investigators co-identified themes after the focus groups. Open coding was performed for the initial thematic analysis, followed by selective coding upon theme identification. Descriptive statistics were used to characterize demographic information from study participants. Results: A total of 6 subjects were interviewed thus far; 3 (50%) males, 3 (50%) Asian, median age in years 39.5 (IQR 33-46.8), and median number of years in practice 12 (IQR 5.9-17.8). Four (67%) self-identified as attending physicians, and 2 (23%) self-identified as pharmacists. Major themes identified include “Providers are cognizant of risks of concomitant opioid and benzodiazepine therapy but may not have changed current practices,” “Common barriers to deprescribing therapy include patient preference and lack of resources (e.g., behavioral health),” and “Negative outcomes include adverse effects and inappropriate use.” Provider resources to mitigate patient risk include the Opioid Risk Tool, prescription monitoring programs, and practice-based quantity limitations. Additional data will be reported at the 2018 Research Appreciation Day. Conclusions: Preliminary results suggest that providers are aware of the risks associated with concomitant opioid and benzodiazepine therapy but face a number of challenges in tapering or discontinuing therapy. These findings may be used to impact trainee education and clinical practice. Final results and conclusions will be presented at the 2018 Research Appreciation Day.