Rates, Trends, and Determinants of Concurrent Prescription of Opioids, Other Central Nervous System Depressants, and Gabapentinoids in Ambulatory Care Settings - Evidence from National Dataset

Purpose: Studies have analyzed the concomitant use of opioids, CNS depressants, and gabapentinoids (gabapentin and pregabalin) in the elderly and patients with chronic pain. However, use of these medications in the general adult population irrespective of condition has not been studied with current national data. Methods: This was a cross-sectional study using National Ambulatory Medical Care Survey (NAMCS) data from 2007 to 2016. Visits were narrowed to adults(18 and older) with at least one opioid or CNS depressant medication. Within this cohort, weighted/non-weighted frequencies of and factors associated with concurrent use of opioids, CNS depressants, and gabapentinoids were determined. Results: Over one billion weighted visits were identified(Non weighted:44,881) with at least one opioid or CNS depressant. Females(61%) and White race(86%) represented the majority with mean age 56 years(± 16.5). Opioids(65%) were most common followed by CNS depressants(47%) then gabapentinoids(10%). Among patients with an opioid medication, 25% were also on at least one CNS depressant or gabapentinoid. Concurrent use increased from 2011 to 2012(+13.8%) then dropped from 2014 to 2016(-12%). Factors associated with concurrent use of opioids and CNS depressants were White race, tobacco use, visits with PCP compared to non-PCP, and >3 comorbidities. Conclusions: Significant percent of patients(65%) were on opioids when analyzed irrespective of disease or age. Despite concerns of increased overdose and misuse with concurrent opioids, CNS depressant and gabapentinoids, a quarter of our cohort were on at least two of these medications. Future studies are needed to decrease concurrent use of these medications.