Objective: This study assessed trends in co-prescribing of opioids with psychotropic medications (COOP) and characterized COOP patterns among Medicare-enrolled older adults with chronic non-cancer pain (CNCP) on long-term opioid therapy (LTOT).

Methods: A retrospective cohort study was conducted using 2012-2018 5% national sample of Medicare administrative claims data. Eligible beneficiaries were continuously enrolled and had no claims with a diagnosis of cancer or hospice use, and ≥2 claims with diagnoses for CNCP conditions within a 30-day period in the 12 months prior to the index date (LTOT initiation). COOP was defined as an overlap between opioids and any class of psychotropic medication (anti-depressants, benzodiazepines, antipsychotics, anticonvulsants, muscle relaxants and nonbenzodiazepine hypnotics) based on their prescription fill dates and days of supply following index date in a given year. The rate of COOP, the co-prescribing intensity (co-prescribing days/total opioid prescription days), average dose, and formulation of the opioids prescribed were calculated for each calendar year.

Results: The eligible study population of individuals on LTOT was 2,384 in 2013 and 2,016 in 2018. The rate of COOP among eligible beneficiaries decreased from 75.25% in 2013 to 69.03% in 2015, and then increased to 71.43% in 2018. Among eligible beneficiaries with at least one day of COOP, the co-prescribing intensity with any class of psychotropic medications showed minimal variation throughout the study period, ranging between 78.57% in 2013 and 75.55% in 2018. Across all the years, the co-prescribing intensity was found to be highest with antidepressants (2013: 51.91% and 2018: 52.61%) followed by benzodiazepines (2013: 28.18% and 2018: 20.42%) and nonbenzodiazepine hypnotics (2013: 14.49% and 2018: 10.60%).

Conclusion: High rates of COOP among older adults with CNCP who initiated LTOT were observed. Future research should investigate the driving factors of COOP and safety associated with various patterns of use.