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Overlapping Prescriptions of Opioids, Benzodiazepines, and Carisoprodol: "Holy Trinity" Prescribing in the State of Florida

NCJ Number
Drug and Alcohol Dependence Volume: 205 Dated: December 2019
Yanning N. Wang; Chris Delcher; Yan Li; Bruce A. Goldberger; Gary M. Reisfield
Date Published
December 2019
12 pages
Since responsible prescribing guidelines indicate that the triple drug combination--opioids, benzodiazepines, and skeletal muscle relaxants, especially carisoprodol--should not be concurrently prescribed, the primary purpose of the current pharmacoepidemiological study was to examine the characteristics of patients receiving this triple combination compared to the group receiving only opioids and benzodiazepines.
The study, which was conducted in Florida, indicates that although the number of exposed patients has declined since 2012, approximately 17,000 Floridians were prescribed this combination in 2017 alone. Demographically, recipients of these prescriptions were younger, more likely to be female, and geographically localized. In addition, these patients were more often associated with a prescriber in the top 1 percent of opioid and/or benzodiazepine prescribing, have more multiple-provider episodes ("doctor shopping"), and receive higher mean daily opioid dosages. These findings raise important issues regarding how frequently prescribers are checking prescription drug monitoring programs, following U.S. Centers for Disease Control and Prevention opioid prescribing guidelines, and/or handling the clinical challenges associated with pharmaceutical management of patients with complex, painful health conditions. (publisher abstract modified)