ABSTRACT
Objective: This study aimed to characterize Z-drug prescribing with and without opioid coprescribing pre- and post-COVID-19 lockdown in the primary care clinics of a large health care system.
Methods: A retrospective, cross-sectional study was conducted that measured the prevalence of Z-drug prescribing with and without opioids for adults aged ≥ 18 years that were seen in the primary care clinics of a large health care system in 2019 and 2020. The pre-COVID time period was defined as March 24, 2019–December 31, 2019, and the post-lockdown time period was defined as March 24, 2020–December 31, 2020.
Results: Among 455,537 adult patients, 6,743 (1.48%) were prescribed a Z-drug during the study period. In addition, 1,064 (0.2%) were coprescribed a Z-drug and an opioid at least once, constituting 15.78% of patients receiving a Z-drug prescription. There was no change in the rate of Z-drug prescription post-lockdown (odds ratio [OR] = 0.978, 95% confidence interval [CI] = 0.942–1.010, P = .233), though odds of coprescribing decreased (OR = 0.883, 95% CI = 0.789–0.988, P = .031). Important correlates of receiving a Z-drug prescription during the study period were older age, White race, and diagnosis of opioid use disorder. Older age and a diagnosis of opioid use disorder were also associated with coprescribing. Receiving a de novo Z-drug prescription post-lockdown was associated with increased age, White race, and diagnosis of bipolar disorder, generalized anxiety disorder, and insomnia.
Conclusions: Rates of Z-drug prescribing were unchanged post-lockdown, while rates of Z-drug with opioid coprescribing decreased. Some patient populations vulnerable to Z-drug adverse effects were at heightened risk of Z-drug prescription, while racial disparities in Z-drug prescribing were observed.
J Clin Psychiatry 2023;84(6):22m14753
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References (44)
- Reuben C, Elgaddal N, Black LI. Sleep Medication Use in Adults Aged 18 and Over: United States, 2020. NCHS Data Brief. 2023;(462):1–8. Accessed February 16, 2023. https://www.cdc.gov/nchs/data/databriefs/db462.pdf
- Brandt J, Leong C. Benzodiazepines and Z-drugs: an updated review of major adverse outcomes reported on in epidemiologic research. Drugs R D. 2017;17(4):493–507. PubMed CrossRef
- Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–1960. PubMed CrossRef
- Treves N, Perlman A, Kolenberg Geron L, et al. Z-drugs and risk for falls and fractures in older adults-a systematic review and meta-analysis. Age Ageing. 2018;47(2):201–208. PubMed CrossRef
- Schifano F, Chiappini S, Corkery JM, et al. An insight into Z-drug abuse and dependence: an examination of reports to the European Medicines Agency database of suspected adverse drug reactions. Int J Neuropsychopharmacol. 2019;22(4):270–277. PubMed CrossRef
- Szmulewicz A, Bateman BT, Levin R, et al. The risk of overdose with concomitant use of Z-drugs and prescription opioids: a population-based cohort study. Am J Psychiatry. 2021;178(7):643–650. PubMed CrossRef
- Scharner V, Hasieber L, Sönnichsen A, et al. Efficacy and safety of Z-substances in the management of insomnia in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing. BMC Geriatr. 2022;22(1):87. PubMed CrossRef
- Tubbs AS, Ghani SB, Naps M, et al. Past-year use or misuse of an opioid is associated with use of a sedative-hypnotic medication: a US National Survey on Drug Use and Health (NSDUH) study. J Clin Sleep Med. 2022;18(3):809–816. PubMed CrossRef
- Tardelli VS, Bianco MCM, Prakash R, et al. Overdose deaths involving non-BZD hypnotic/sedatives in the USA: trends analyses. Lancet Reg Health Am. 2022;10:100190. PubMed CrossRef
- Xiong J, Lipsitz O, Nasri F, et al. Impact of COVID-19 pandemic on mental health in the general population: a systematic review. J Affect Disord. 2020;277:55–64. PubMed CrossRef
- Choudhry AA, Shahzeen F, Choudhry SA, et al. Impact of COVID-19 infection on quality of sleep. Cureus. 2021;13(9):e18182. PubMed CrossRef
- Milani SA, Raji MA, Chen L, et al. Trends in the use of benzodiazepines, Z-hypnotics, and serotonergic drugs among us women and men before and during the COVID-19 pandemic. JAMA Netw Open. 2021;4(10):e2131012. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2785392. Accessed August 26, 2022. PubMed CrossRef
- Murphy MT, Latif U. Pain during COVID-19: a comprehensive review and guide for the interventionalist. Pain Pract. 2021;21(1):132–143. PubMed CrossRef
- Currie JM, Schnell MK, Schwandt H, et al. Prescribing of opioid analgesics and buprenorphine for opioid use disorder during the COVID-19 pandemic. JAMA Netw Open. 2021;4(4):e216147. PubMed CrossRef
- Anderson KE, Basting JL, Gifeisman RI, et al. High prescribing and state-level variation in Z-drug use among Medicare patients. medRxiv. Preprint posted online May 10, 2022. doi:10.1101/2022.05.10.22274909 >
- Cadogan CA, Ryan C, Cahir C, et al. Benzodiazepine and Z-drug prescribing in Ireland: analysis of national prescribing trends from 2005 to 2015. Br J Clin Pharmacol. 2018;84(6):1354–1363. PubMed CrossRef
- Kim HM, Gerlach LB, Van T, et al. Predictors of long-term and high-dose use of zolpidem in veterans. J Clin Psychiatry. 2019;80(2):18m12149. PubMed CrossRef
- Esechie A, Kuo Y-F, Goodwin JS, et al. Trends in prescribing pattern of opioid and benzodiazepine substitutes among Medicare part D beneficiaries from 2013 to 2018: a retrospective study. BMJ Open. 2021;11(11):e053487. PubMed CrossRef
- Mokhar A, Tillenburg N, Dirmaier J, et al. Potentially inappropriate use of benzodiazepines and Z-drugs in the older population-analysis of associations between long-term use and patient-related factors. PeerJ. 2018;6(5):e4614. PubMed CrossRef
- Woods A, Begum M, Gonzalez-Chica D, et al. Long-term benzodiazepines and z-drug prescribing in Australian general practice between 2011 and 2018: A national study. Pharmacol Res Perspect. 2022;10(1):e00896. PubMed CrossRef
- Landolt S, Rosemann T, Blozik E, et al. Benzodiazepine and Z-drug use in Switzerland: prevalence, prescription patterns and association with adverse healthcare outcomes. Neuropsychiatr Dis Treat. 2021;17:1021–1034. PubMed CrossRef
- Gerlach LB, Maust DT, Leong SH, et al. Factors associated with long-term benzodiazepine use among older adults. JAMA Intern Med. 2018;178(11):1560–1562. PubMed CrossRef
- Soyombo S, Stanbrook R, Aujla H, et al. Socioeconomic status and benzodiazepine and Z-drug prescribing: a cross-sectional study of practice-level data in England. Fam Pract. 2020;37(2):194–199. PubMed CrossRef
- Alimoradi Z, Gozal D, Tsang HWH, et al. Gender-specific estimates of sleep problems during the COVID-19 pandemic: systematic review and meta-analysis. J Sleep Res. 2022;31(1):e13432. PubMed CrossRef
- Salfi F, Lauriola M, Amicucci G, et al. Gender-related time course of sleep disturbances and psychological symptoms during the COVID-19 lockdown: a longitudinal study on the Italian population. Neurobiol Stress. 2020;13:100259. PubMed CrossRef
- Tardelli VS, Fidalgo TM, Martins SS. How do medical and non-medical use of Z-drugs relate to psychological distress and the use of other depressant drugs? Addict Behav. 2021;112:106606. PubMed CrossRef
- Nunes J, Jean-Louis G, Zizi F, et al. Sleep duration among black and white Americans: results of the National Health Interview Survey. J Natl Med Assoc. 2008;100(3):317–322. PubMed CrossRef
- Cheng P, Cuellar R, Johnson DA, et al. Racial discrimination as a mediator of racial disparities in insomnia disorder. Sleep Health. 2020;6(5):543–549. PubMed CrossRef
- Amyx M, Xiong X, Xie Y, et al. Racial/ethnic differences in sleep disorders and reporting of trouble sleeping among women of childbearing age in the United States. Matern Child Health J. 2017;21(2):306–314. PubMed CrossRef
- Hoffman KM, Trawalter S, Axt JR, et al. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296–4301. PubMed CrossRef
- Kaufmann CN, Spira AP, Alexander GC, et al. Trends in prescribing of sedative-hypnotic medications in the USA: 1993–2010. Pharmacoepidemiol Drug Saf. 2016;25(6):637–645. PubMed CrossRef
- Glass J, Lanctôt KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331(7526):1169–1173. PubMed CrossRef
- Schepis TS, Teter CJ, Simoni-Wastila L, et al. Prescription tranquilizer/sedative misuse prevalence and correlates across age cohorts in the US. Addict Behav. 2018;87:24–32. PubMed CrossRef
- Lebrasseur A, Fortin-Bédard N, Lettre J, et al. Impact of the COVID-19 pandemic on older adults: rapid review. 2021;4(2):e26474.
- De Pue S, Gillebert C, Dierckx E, et al. The impact of the COVID-19 pandemic on wellbeing and cognitive functioning of older adults. Sci Rep. 2021;11(1):4636. PubMed CrossRef
- Morin CM, Bjorvatn B, Chung F, et al. Insomnia, anxiety, and depression during the COVID-19 pandemic: an international collaborative study. Sleep Med. 2021;87:38–45. PubMed CrossRef
- Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res. 2018;27(6):e12710. PubMed CrossRef
- Linnet K, Thorsteinsdottir HS, Sigurdsson JA, et al. Co-prescribing of opioids and benzodiazepines/Z-drugs associated with all-cause mortality: A population-based longitudinal study in primary care with weak opioids most commonly prescribed. Front Pharmacol. 2022;13:932380. PubMed CrossRef
- Doherty AJ, Boland P, Reed J, et al. Barriers and facilitators to deprescribing in primary care: a systematic review. BJGP Open. 2020;4(3):bjgpopen20X101096. PubMed CrossRef
- Treating Substance Use Disorder in Older Adults: Updated 2020. Substance Abuse and Mental Health Services Administration; 2020. Accessed August 28, 2022. https://pubmed.ncbi.nlm.nih.gov/34106564/
- Conti EC, Stanley MA, Amspoker AB, et al. Sedative-hypnotic use among older adults participating in anxiety research. Int J Aging Hum Dev. 2017;85(1):3–17. PubMed CrossRef
- Mason M, Soliman R, Kim HS, et al. Disparities by sex and race and ethnicity in death rates due to opioid overdose among adults 55 years or older, 1999 to 2019. JAMA Netw Open. 2022;5(1):e2142982. PubMed CrossRef
- Soni A, Thiyagarajan A, Reeve J. Feasibility and effectiveness of deprescribing benzodiazepines and Z-drugs: systematic review and meta-analysis. Addiction. 2023;118(1):7–16. PubMed CrossRef
- Rasmussen AF, Poulsen SS, Oldenburg LIK, et al. The barriers and facilitators of different stakeholders when deprescribing benzodiazepine receptor agonists in older patients—a systematic review. Metabolites. 2021;11(4):254. PubMed CrossRef
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