OBJECTIVES: Co-prescribing of opioids, benzodiazepines (BZDs) can result in an increase in rates of adverse events, overdose, and death, warranting close monitoring and consideration when treating patients with these medications. Recent opioid prescribing guidelines issued by the Centers for Disease Control and Prevention (CDC) and the Surgeon General of the United States specifically advise against co-prescribing of these medications. However, state variation and effect of socio-demographic characteristics on co-prescribing of these medications in Medicaid population have not been examined before. Therefore, this study examines the impact of socio-demographic characteristics and state variation on co-prescribing of prescription opioids (POs) and benzodiazepines in Medicaid population.

METHODS: This study utilized a retrospective analysis of Medicaid claims data from 2014. The study included 8,993,999 observations (patient prescriptions) representing 393,984 adults age 18-64 years from 17 states (that use either POs or BZDs). Analyses were stratified by age, gender, race/ethnicity, type of insurance (managed care versus fee-for-service), and state.

RESULTS: In 2014,33.63% of adults reported using POs and 13.31% reported using BZDs. Among adults with an opioid prescription, 22.53% were also prescribed a BZDs, of which 76.59% had co-prescriptions. Among adults with POs and BZDs co-prescriptions, 71.35% were female, 61.38% were non-Hispanic White, 36.34% were 50-64 years old, and 63.65% had managed care insurance through Medicaid. Among adults in each of the 17 states, Montana experienced the highest proportion of co-prescriptions (22.48%) while Tennessee experienced the lowest proportion of co-prescriptions (6.30%).

CONCLUSIONS: A larger proportion of non-Hispanic White population and older population (age 50-64) in Medicaid experience higher rates of co-prescriptions of opioids and benzodiazepines compared with other race groups and age groups respectively. Adult Medicaid populations receiving co-prescriptions of opioids and benzodiazepines varied significantly between states. Policy interventions are needed to reduce disparities in co-prescribing practices of opioids and benzodiazepines in Medicaid population.