De-prescribing opioids among Medicaid patients with long-term opioid use

Background: Guidelines encourage deprescribing opioids for long-term opioid patients, especially those using opioids and benzodiazepines, z-drugs, or muscle relaxants ("other respiratory depressants"). Objective: Were long-term opioid patients who were prescribed other respiratory depressants more likely to have deprescribing opioid trajectories? Design: Cross-sectional retrospective study using pharmacy and professional claims from 2015 to 2019. Adjusted logistic regression models were stratified on low (<50 morphine milligram equivalents; MME) and high (>50 MME) starting opioid doses. We reported predicted probabilities with 95 % confidence intervals. Subjects: Nevada and Colorado Medicaid beneficiaries 18-64 years old without cancer diagnoses with long-term (120 days' supply/6 months) opioid use (117,400 person-windows). Measures: We used group-based trajectory modeling in Stata to identify characteristic 12-month dosing trajectories. Using the resulting trajectories, we assigned the outcome = 1 if the observation had a deprescribing trajectory (versus a constant trajectory). Binary exposure variables indicated that the patient had an opioid prescription overlapping with 1, 2, or 3 types of other respiratory depressants. Results: Among patients with a low starting opioid dose, the predicted probabilities of a deprescribing trajectory were lower when the patient had overlapping other respiratory depressants compared to when they did not (0 respiratory depressants: 0.33, [0.32, 0.33]; vs. 1 respiratory depressant: 0.22, [0.20, 0.23]; 2 respiratory depressants: 0.18 [0.16, 0.20]; 3 respiratory depressants:0.20 [0.13, 0.27]). Among patients with a high starting opioid dose, we observed similar results. Conclusions and relevance: Targeted provider-level interventions to support deprescribing for long-term opioid patients using opioids and other respiratory depressants may provide particularly high-value care.