(128) Real-World Patterns of Opioid Analgesic, Gabapentinoid, and Benzodiazepine Prescriptions in the United States: A Drug Utilization Study (2017-2021)

Publication Number: 789

Background: Opioids are a leading cause of prescription overdose and death in the US. Understanding opioid prescription utilization patterns enable public health professionals to assess the state of the opioid epidemic. Thus, the Food and Drug Administration enacted a class-wide Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) Program to address risks associated with prescribing of opioids. This drug utilization study was conducted as part of the REMS.

Objectives: To estimate the number of incident patients prescribed opioids; and, to estimate the proportion of concomitant use of these opioids with gabapentinoids or benzodiazepines per year from 2017 to 2021.

Methods: This retrospective cohort study used IQVIA’s Longitudinal Prescription (LRx) and National Prescription Audit (NPA) databases. LRx has prescription data on > 252 million unique de-identified patients and one million physicians. NPA data is used to project analyses to retail national estimates that are representative of the US population. Study outcomes were total annual number of incident patients prescribed REMS program opioids, and the proportion of concomitant opioid use with gabapentinoids or benzodiazepines. Characteristics of the first REMS opioid prescription by dose, units dispensed, and duration of therapy were reported annually. Subgroup analyses by age, sex, and prescriber specialty were performed.

Results: The number of incident patients receiving REMS prescription opioids decreased 22.7% from 33.9 to 26.2 million between 2017 and 2020, with an increase of 4.7% to 27.5 million in 2021. This pattern was consistent across prescriber specialties and active pharmaceutical ingredients. Majority of patients were female and aged 18-64 years. The most frequently prescribed opioids were hydrocodone, codeine, oxycodone, and tramadol. A decrease was observed in the total dose, daily dose, and number of units of incident prescriptions dispensed to new patients receiving opioids, while the duration of incident treatment episodes was steady from 2017 to 2021. The duration of incident treatment episodes for overall opioids was stable between 2007 to 2021, ranging from 7.3 to 8.8 days. Concomitant use of opioids and benzodiazepine decreased, while that of gabapentinoids increased.

Conclusions: We observed a decrease in REMS opioid-receiving patients between 2017 and 2020, and an increase in 2021. An increase in concomitant prescriptions of opioids and gabapentinoids was observed. This study provides insight into the state of the opioid epidemic in the US, while also elucidating the national efforts in addressing said epidemic.