Prevalence and correlates of the misuse of z-drugs and benzodiazepines in the National Survey on Drug Use and Health

Risk of drug-related death associated with co-prescribing of gabapentinoids and Z-drugs among people receiving opioid-agonist treatment: A national retrospective cohort study

BACKGROUND

Prescribing of gabapentinoids and Z-drug-hypnotics has increased in the population and among people receiving opioid-agonist treatment (OAT) for opioid dependence. Evidence is mixed on whether co-prescribing of sedatives such as gabapentinoids and Z-drugs during OAT increases risk of drug-related death (DRD).

METHODS

We conducted a retrospective cohort study of individuals prescribed OAT between 2011 and 2020 in Scotland. Prescribing records were linked to mortality data and other healthcare datasets (sociodemographic, comorbidity). We identified episodes of treatment with gabapentinoids/Z-drugs and used multivariable quasi-Poisson regression to model associations between co-prescription and DRD risk.

RESULTS

Among 46,602 individuals with 304,783 person-years of follow-up, we found that co-prescription was common, with 25 % and 34 % ever being co-prescribed gabapentinoids and Z-drugs, respectively. Gabapentinoid exposure was strongly associated (adjusted hazard ratio (aHR)=2·18, 95 % CI=1·92, 2·46) and Z-drug exposure moderately associated (aHR=1·39, 95 % CI=1·15, 1·66) with elevated risk of DRD. Gabapentinoid exposure was associated with DRD risk on and off OAT; Z-drug exposure was less strongly associated with DRD risk when on OAT.

CONCLUSIONS

Co-prescription of gabapentinoids and Z-drugs is common among OAT patients. However, co-prescription is associated with increased risk of DRD. Alternatives to prescribing sedative medications to OAT patients and/or greater monitoring - if prescribed - are needed.

Age and gender differences in motives for z-drug misuse: Findings from the 2015 to 2019 NSDUH survey

BACKGROUND AND OBJECTIVES

Approximately 9% of people who are exposed to a nonbenzodiazepine sedative-hypnotic medication ("z-drug") misuse this medication, yet, the reasons why people misuse z-drugs are not well-characterized.

METHODS

Using population survey data, we examined gender and age differences in motives for z-drug misuse.

RESULTS

Results suggested women and older adults have higher odds of misusing z-drugs for sleep, and young adults have higher odds of misusing for recreation.

DISCUSSION AND CONCLUSIONS

Although the majority of people who misuse z-drugs report misusing to manage sleep, this is particularly common in women and older adults.

SCIENTIFIC SIGNIFICANCE

Addressing inadequately treated sleep concerns may help mitigate z-drug misuse.

Z-Drug Use and Benzodiazepine Use and Misuse Among LGB Populations: The Role of Psychological Distress

BACKGROUND

Z-drugs (hypnotics such as zolpidem, zopiclone, and zaleplon) and benzodiazepines (BZDs) are sedative medications with misuse liability. The goals of this study are to report the (1) prevalence of past-year any Z-drug use, any BZD use, and any BZD misuse by sexual identity category and psychological distress; (2) associations among these 3 categories between sexual identity and past-year psychological distress; (3) associations among these 3 categories with sexual identity by past-year psychological distress status.

METHODS

Data were collected from the National Survey on Drug Use and Health (years 2015-2019 [n = 210,392]), a yearly representative national household survey of the American population. We report prevalences of any Z-drug use, any BZD use, and any BZD misuse by sexual identity and past-year psychological distress status. We ran logistic regressions with complex survey design with the 3 dichotomous variables described above as the dependent variables, stratified and not-stratified by psychological distress.

RESULTS

Prevalence of any Z-drug an BZD use and any BZD misuse were higher among LGB (lesbian/gay/bisexual) populations, especially gay men and bisexual women. Psychological distress was positively associated with any Z-drug and BZD use and any BZD misuse. Women were at higher risk of Z-drug (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.18-1.37) and BZD use (OR, 1.64; 95% CI, 1.55-1.73), but lower risk of BZD misuse (OR, 0.82; 95% CI, 0.76-0.88). When stratifying by psychological distress, differences between LGB and heterosexuals were more pronounced among those without past-year psychological distress, especially gay men and bisexual women.

CONCLUSIONS

The presence of psychological distress attenuates the disparities between LGB and heterosexual individuals in Z-drug use and BZD use and misuse.

Development and evaluation of a personalised sleep care plan on child and adolescent in-patient mental health wards

AIMS AND METHOD

The study evaluated a package of measures to improve sleep on psychiatric wards admitting patients from children and young people's services (CYPS). Sleep disturbance has significant impact on adolescent mental health, and in-patient wards can directly cause sleep disturbance, independent of the problem that led to admission. We developed a CYPS-specific package (TeenSleepWell) that promoted a better sleep environment, enhanced staff education about sleep, screened for sleep disorders, and raised awareness of benefits and side-effects of hypnotics. This included personalised sleep care plans that allowed a protected 8 h sleep period when safe.

RESULTS

Evaluation over 2 years showed enhanced in-patient care: 57% of patients were able to have a protected sleep period. There was no increase in adverse events and there was a decrease in hypnotics issued.

CLINICAL IMPLICATIONS

Improving sleep during in-patient CYPS admissions is possible and personalised sleep care plan should be a care standard.

Incidence and Prevalence of Pain Medication Prescriptions in Pathologies with a Potential for Chronic Pain

BACKGROUND

Heightened risks of dependence, addiction, anxiolytic effects, or prescription overdose death due to long-term use of pain medication have increased awareness about extended pain medication use in chronic pain populations. The goal of this study was to evaluate the incidence and prevalence of pain medication prescriptions from 2012 to 2022 in common pathologies with a potential for chronic pain.

METHODS

A retrospective cohort study was conducted using electronic health records from TriNetX (Cambridge, Massachusetts) Global Collaborative Network. For 10 distinct cohorts (total n = 9,357,584 patients), pain medication prescriptions were extracted for five classes, namely nonsteroidal anti-inflammatory drug (NSAIDs) and acetaminophen, opioids, gabapentinoids, neuropathic mood agents, and muscle relaxants. Annual incidence and prevalence of each class of medication were evaluated for the past 11 yr.

RESULTS

From 2012 to 2022, there was a significant increase in prescriptions of NSAIDs, except for patients with fibromyalgia, and persistent spinal pain syndrome (PSPS) type 2. Interestingly, over time, prescriptions of opioids in patients with complex regional pain syndrome, endometriosis, osteoarthritis, and PSPS type 2 increased, as did prescriptions of muscle relaxants for all cohorts except those with fibromyalgia. Incidence of prescriptions of neuropathic mood agents is high for patients with complex regional pain syndrome (both types) and PSPS type 2. Only for benzodiazepines did there seem to be a decline over the years, with a significantly decreased time trend in patients with complex regional pain syndrome type 1, fibromyalgia, and PSPS type 2.

CONCLUSIONS

During the last 11 yr, an increase in incidence of NSAIDs and acetaminophen, opioids, neuropathic agents, and muscle relaxants was observed. Only prescriptions of benzodiazepines significantly decreased over time in specific cohorts. Overall, patients with PSPS type 2 and complex regional pain syndrome (both types) consume a broad variety of pain medication classes.

EDITOR’S PERSPECTIVE