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Albertsson ÞÍ, Jónsdóttir F, Kárason S, Sigurdsson MI. The incidence of new and persistent benzodiazepine use after surgery. Surgery 2023; 173:1205-1212. [PMID: 36759212 DOI: 10.1016/j.surg.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND It is possible that a portion of new and new persistent use of benzodiazepines is among individuals who start using the medications before or after surgery. We studied the incidence of new and new persistent benzodiazepine use among patients undergoing surgery. METHODS Retrospective, single-center, population-based cohort of all individuals ≥18 years undergoing first surgery between January 2, 2006 and December 31, 2018 with a year of follow-up for filled medications. Benzodiazepine-naïve patients were defined as not filling a prescription from a year to 31 days before surgery. Patients with new use were naïve patients who filled a prescription between 30 days before and 14 days after surgery, and patients with new persistent use were patients with new use who filled a prescription between 15 days and a year after surgery. Patient and procedural characteristics and prescription filling patterns between the groups were compared. RESULTS A total of 55,997 patients (32,136 women [57.4%]; median [interquartile range] age, 55 [39, 69] years) were included. The incidence of new use among naïve patients was 2.7% (95% confidence interval, 2.6%-2.8%; n = 1,311), and, of those, 43.7% (95% confidence interval, 41.0%-46.5%; n = 571) had new persistent benzodiazepine use. Approximately 10% of patients with new use filled a prescription for benzodiazepine in every 30-day window during the follow-up period. CONCLUSION A small portion of surgical patients begin benzodiazepine use perioperatively, but subsequently half fill criteria for persistent use. This highlights the importance of identifying strategies to minimize both new use and the progression of new use into persistent use in surgical patients.
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Affiliation(s)
| | - Freyja Jónsdóttir
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavík, Iceland; Hospital Pharmacy Landspítali-The National University Hospital, Reykjavík, Iceland
| | - Sigurbergur Kárason
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Department of Anesthesiology and Critical Care Medicine, Landspitali-The National University Hospital, Reykjavík, Iceland
| | - Martin I Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Department of Anesthesiology and Critical Care Medicine, Landspitali-The National University Hospital, Reykjavík, Iceland.
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Linnet K, Thorsteinsdottir HS, Sigurdsson JA, Sigurdsson EL, Gudmundsson LS. 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. [PMID: 36147347 PMCID: PMC9485885 DOI: 10.3389/fphar.2022.932380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: The risk of mortality associated with the co-prescribing of benzodiazepines and opioids has been explored in a number of papers mainly focusing on strong opioids. The mortality risk associated with the use of weak opioids has not been dealt with to a similar extent. Objective: To assess the mortality risk in primary care patients with consistent 3-year co-prescribing of benzodiazepine/Z-drugs (benzodiazepine receptor modulators) and mainly weak opioids (codeine, tramadol). Methods: Of 221,804 patients contacting the primary healthcare centres, 124,436 were selected for further analysis, 88,832 participants fulfilled the inclusion criteria, aged 10–69 years and were divided into four groups with neither any use of benzodiazepines/Z-drugs nor opioids as Group 1, 3 years’ use of opioids and no/minimal benzodiazepines/Z-drugs as Group 2, with benzodiazepines/Z-drugs and no/minimal opioids as Group 3, and finally both benzodiazepines/Z-drugs and opioids as Group 4. Hazard ratios were calculated with the no-drug group as a reference, using Cox proportional hazards regression model adjusted for age, sex, number of chronic conditions and cancer patients excluded (n = 87,314). Results: Hazard ratios for mortality increased both in Group 3 where it was 2.66 (95% CI 2.25–3.09) and in Group 4 where it was 5.12 (95% CI 4.25–6.17), with increased dose and higher number of chronic conditions. In Group 4 an opioid dose-dependent increase in mortality among persons using >1000 DDDs benzodiazepines/Z-drugs was observed when those on less than ≤300 DDDs of opioids with HR 4.94 (95% CI 3.54–6.88) were compared to those on >300 DDDs with HR 7.61/95% CI 6.08–9.55). This increase in mortality was not observed among patients on <1000 DDDs of benzodiazepines/Z-drugs. Conclusion: The study supports evidence suggesting that mortality increases in a dose-dependent manner in patients co-prescribed benzodiazepines/Z-drugs and weak opioids (codeine, tramadol). An association between the number of chronic conditions and a rise in mortality was found. Long-term use of these drugs should preferably be avoided. Non-pharmacological therapy should be seriously considered instead of long-term use of benzodiazepines/Z-drugs, and deprescribing implemented for chronic users of these drugs when possible.
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Affiliation(s)
- Kristjan Linnet
- Development Centre for Primary Healthcare in Iceland, Primary Health Care of the Capital Area, Reykjavik, Iceland
- *Correspondence: Kristjan Linnet,
| | | | - Johann Agust Sigurdsson
- Development Centre for Primary Healthcare in Iceland, Primary Health Care of the Capital Area, Reykjavik, Iceland
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Emil Larus Sigurdsson
- Development Centre for Primary Healthcare in Iceland, Primary Health Care of the Capital Area, Reykjavik, Iceland
- Department of Family Medicine, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Hwang S, Son H, Kim M, Lee SK, Jung KY. Association of Zolpidem With Increased Mortality in Patients With Brain Cancer: A Retrospective Cohort Study Based on the National Health Insurance Service Database. J Clin Neurol 2022; 18:65-70. [PMID: 35021278 PMCID: PMC8762495 DOI: 10.3988/jcn.2022.18.1.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Zolpidem is one of the most common hypnotics prescribed to treat insomnia worldwide. However, there are numerous reports of a positive association between zolpidem and mortality, including an association with increased cancer-specific mortality found in a Taiwanese cohort study. This study aimed to determine the association between zolpidem use and brain-cancer-specific mortality in patients with brain cancer. Methods This population-based, retrospective cohort study analyzed data in the National Health Insurance Service database. All incident cases of brain cancer at an age of ≥18 years at the time of brain cancer diagnosis over a 15-year period (2003–2017) were included. A multivariate Cox regression analysis after adjustment for covariables was performed to evaluate the associations of zolpidem exposure with brain-cancer-specific and all-cause mortality. Results This study identified 38,037 incident cases of brain cancer, among whom 11,823 (31.1%) patients were exposed to zolpidem. In the multivariate Cox regression model, the brain-cancer-specific mortality rate was significantly higher in patients who were prescribed zolpidem than in those with no zolpidem prescription (adjusted hazard ratio [HR]=1.14, 95% confidence interval [CI]=1.08–1.21, p<0.001). Zolpidem exposure was significantly associated with increased brain-cancer-specific mortality after adjustment in younger adults (age 18–64 years; adjusted HR=1.37, 95% CI=1.27–1.49) but not in older adults (age ≥65 years; adjusted HR=0.94, 95% CI=0.86–1.02). Conclusions Zolpidem exposure was significantly associated with increased brain-cancer-specific mortality in patients with brain cancer aged 18–64 years. Further prospective studies are warranted to understand the mechanism underlying the effect of zolpidem on mortality in patients with brain cancer.
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Affiliation(s)
- Sungeun Hwang
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyoshin Son
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience and Protein Metabolism Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Sensory Organ Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.
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Management of Insomnia Disorder. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gosselin E, Simard M, Lunghi C, Sirois C. Trends in benzodiazepine and alternative hypnotic use in relation with multimorbidity among older adults in Quebec, Canada. Pharmacoepidemiol Drug Saf 2021; 31:322-333. [PMID: 34748234 DOI: 10.1002/pds.5383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 10/15/2021] [Accepted: 11/01/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Benzodiazepines and other hypnotic alternatives are associated with increased risks of adverse events. Heightened awareness of risks may have changed prescribing habits over the years. However, these trends are not fully described, especially in vulnerable people such as multimorbid older adults. OBJECTIVE We aimed to describe the annual prevalence of benzodiazepine and other hypnotic use in relation to multimorbidity among older adults in the province of Quebec, Canada, from 2000 to 2016. METHOD We conducted a population-based study using the Quebec Integrated Chronic Disease Surveillance System. We included all individuals aged ≥66 years covered by the public drug plan. For each year, we evaluated the sex- and age-standardized proportion of benzodiazepine and other hypnotic users, defined as individuals with at least one drug claim in the year. We stratified our results according to multimorbidity and used log-binomial regression to study trends. RESULTS The proportion of individuals using benzodiazepines decreased from 34.8% in 2000 to 24.8% in 2016 (p for trend <0.001). Multimorbid people (≥2 chronic diseases) remained the highest users over the years, with 43.3% and 30.6% of them being users in 2000 and 2016, respectively. Conversely, the proportion of users increased for other hypnotics, particularly for trazodone and quetiapine, rising from 5.4% to 8.4% (p < 0.001), and especially among multimorbid individuals (from 7.4% to 11.6%). CONCLUSION Older adults used benzodiazepines less frequently but quetiapine and trazodone more frequently in recent years. The use of these medications, particularly in multimorbid people at risk of adverse events, must be addressed.
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Affiliation(s)
- Emmanuelle Gosselin
- Laval University, Quebec City, Quebec, Canada.,Institut national de santé publique du Québec, Quebec City, Quebec, Canada.,Centre d'excellence sur le vieillissement de Québec, Quebec City, Quebec, Canada
| | - Marc Simard
- Laval University, Quebec City, Quebec, Canada.,Institut national de santé publique du Québec, Quebec City, Quebec, Canada
| | | | - Caroline Sirois
- Laval University, Quebec City, Quebec, Canada.,Institut national de santé publique du Québec, Quebec City, Quebec, Canada.,Centre d'excellence sur le vieillissement de Québec, Quebec City, Quebec, Canada
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Majnarić LT, Wittlinger T, Stolnik D, Babič F, Bosnić Z, Rudan S. Prescribing Analgesics to Older People: A Challenge for GPs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114017. [PMID: 32516932 PMCID: PMC7312581 DOI: 10.3390/ijerph17114017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 01/17/2023]
Abstract
Background: Due to population aging, there is an increase in the prevalence of chronic diseases, and in particular musculoskeletal diseases. These trends are associated with an increased demand for prescription analgesics and an increased risk of polypharmacy and adverse medication reactions, which constitutes a challenge, especially for general practitioners (GPs), as the providers who are most responsible for the prescription policy. Objectives: To identify patterns of analgesics prescription for older people in the study area and explore associations between a long-term analgesic prescription and comorbidity patterns, as well as the prescription of psychotropic and other common medications in a continuous use. Methods: A retrospective study was conducted in 2015 in eastern Croatia. Patients were GP attenders ≥40 years old (N = 675), who were recruited during their appointments (consecutive patients). They were divided into two groups: those who have been continuously prescribed analgesics (N = 432) and those who have not (N = 243). Data from electronic health records were used to provide information about diagnoses of musculoskeletal and other chronic diseases, as well as prescription rates for analgesics and other medications. Exploratory methods and logistic regression models were used to analyse the data. Results: Analgesics have been continuously prescribed to 64% of the patients, mostly to those in the older age groups (50–79 years) and females, and they were indicated mainly for dorsalgia symptoms and arthrosis. Non-opioid analgesics were most common, with an increasing tendency to prescribe opioid analgesics to older patient groups aged 60–79 years. The study results indicate that there is a high rate of simultaneous prescription of analgesics and psychotropic medications, despite the intention of GPs to avoid prescribing psychotropic medications to patients who use any option with opioid analgesics. In general, receiving prescription analgesics does not exceed the prescription for chronic diseases over the rates that can be found in patients who do not receive prescription analgesics. Conclusion: Based on the analysis of comorbidities and parallel prescribing, the results of this study can improve GPs’ prescription and treatment strategies for musculoskeletal diseases and chronic pain conditions.
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Affiliation(s)
- Ljiljana Trtica Majnarić
- Department of Internal Medicine, Family Medicine and the History of Medicine, Faculty of Medicine, University Josip Juraj Strossmayer, 31000 Osijek, Croatia;
- Department of Public Health, Faculty of Dental Medicine, University Josip Juraj Strossmayer, 31000 Osijek, Croatia; (Z.B.); (S.R.)
| | - Thomas Wittlinger
- Department of Cardiology, Asklepios Hospital, 38642 Goslar, Germany
- Correspondence:
| | - Dunja Stolnik
- Family Medicine Practice, Health Center Osijek, 31000 Osijek, Croatia;
| | - František Babič
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, 04201 Košice, Slovak Republic;
| | - Zvonimir Bosnić
- Department of Public Health, Faculty of Dental Medicine, University Josip Juraj Strossmayer, 31000 Osijek, Croatia; (Z.B.); (S.R.)
| | - Stjepan Rudan
- Department of Public Health, Faculty of Dental Medicine, University Josip Juraj Strossmayer, 31000 Osijek, Croatia; (Z.B.); (S.R.)
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