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    Patterns, Factors and Outcomes associated with Gabapentin use in Combination with Opioids and Benzodiazepines among Social Security Disability Insurance (SSDI)-eligible Medicare Beneficiaries

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    Olopoenia_umaryland_0373D_11284.pdf
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    Author
    Olopoenia, Abisola
    Advisor
    Simoni-Wastila, Linda
    Date
    2021
    Embargo until
    08/04/2022
    Type
    dissertation
    
    Metadata
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    Abstract
    Background: Little is known about the patterns, factors, and public health outcomes associated with concurrent utilization of gabapentin, opioids, and benzodiazepines (GABA+OP+BZD) Objective: To examine the patterns, factors, and public health outcomes associated with concurrent utilization of GABA+OP+BZD among Social Security Disability Insurance (SSDI) eligible beneficiaries. Methods: Using a 5% sample of 2013-2016 Medicare data, we utilized a retrospective cohort design to examine the following patterns of concurrent utilization: monotherapy, dual therapy, tri-therapy, switching, augmentation, discontinuation, and continuation. Similarly, a retrospective cohort design was utilized to examine the sociodemographic and clinical factors associated with the longest concurrent medication utilization episode, defined based on the overlap of prescriptions for GABA+OP+BZD. We used a nested case control design to examine the association between concurrent utilization of GABA+OP+BZD and adverse outcomes (respiratory depression, substance and opioid related overdose, and adverse drug-related events) among disabled beneficiaries with acute pain [AP], chronic pain [CP], and mental health conditions [MH]. Results: Among disabled beneficiaries, gabapentin initiators were significantly more likely to become dual and tri-therapy users (p<0.01) and to augment therapy (50.1%) when compared to opioid (28.7%) and benzodiazepine (38.7%) users; the majority augmented within 2-months after initiating therapy. Back pain [AOR(95%CI): 1.23(1.07-1.41)], chronic pain [1.27 (1.07-1.51)], mental health [1.16 (1.02-1.33)], opioid dose [1.05 (1.03-1.06)] and duration [1.07 (1.06-1.07)], and benzodiazepine duration [1.06 (1.05-1.06)] were positive predictors of having longest concurrent use involving GABA+OP+BZD. Concurrent GABA+OP+BZD use was associated with increased odds of respiratory depression [AP: 1.35 (1.19-1.52), CP:1.24 (1.11-1.38) and MH: 1.16 (1.02-1.32)], opioid related overdose [AP: 1.43 (1.04-1.98), CP: 1.47 (1.07-2.00) and MH: 1.44 (1.04-2.00)], substance related overdose[AP: 1.77 (1.26-2.50), CP: 1.70 (1.24-2.34) and MH: 1.92 (1.31-2.82)] and adverse drug related events[AP: 1.36 (1.22-1.50), CP: 1.23 (1.10-1.36) and MH: 1.15 (1.02-1.30)]. Conclusion: Our study provides the first evidence of patterns, factors, and outcomes associated with concurrent utilization of GABA+OP+BZD. Given noted adverse outcomes associated with GABA+OP+BZD, it is imperative that the benefits and risks of co-prescribing these medications be examined comprehensively, especially for those at the greatest risk of being prescribed these medications.
    Description
    University of Maryland, Baltimore. Pharmaceutical Health Services Research, Ph.D. 2021
    Keyword
    opioids
    Benzodiazepines
    Gabapentin
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/18125
    Collections
    Theses and Dissertations School of Pharmacy
    Theses and Dissertations All Schools

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