TY - JOUR
T1 - Factors associated with benzodiazepine prescribing in community mental health settings
AU - Jessell, Lauren
AU - Stanhope, Victoria
AU - Manuel, Jennifer I.
AU - Mateu-Gelabert, Pedro
N1 - Funding Information:
This study and Dr. Victoria Stanhope's time was supported by the National Institute of Mental Health ( R01MH099012 ) Person-Centered Care Planning and Service Engagement. Lauren Jessell's time was supported by the National Institute on Drug Abuse ( 5T32 DA07233 ). Dr. Jennifer Manuel's time was supported by the National Institute on Drug Abuse ( K01DA035330 ). Dr. Mateu-Gelabert’s time was supported by the National Institute on Drug Abuse ( R01DA041298 and R01DA041501 ). The content is solely the responsibility of the authors and does not represent the official views of the National Institute of Mental Health or the National Institute on Drug Abuse .
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/2
Y1 - 2020/2
N2 - Objective: One class of drugs increasingly involved in overdose fatalities is benzodiazepines. Prescribing benzodiazepines to people with co-occurring substance use disorders (SUDs) poses risk for overdose and dependence and is not recommended. The current study reports prevalence rates of prescribing benzodiazepines to people with and without co-occurring SUDs in community mental health settings. Clinical and socio-demographic factors associated with receipt of a benzodiazepine were examined, including whether factors potentially indicative of prescribing biases (older age and race) moderated the relationship between having a co-occurring SUD and receiving a benzodiazepine prescription. Methods: Retrospective chart review data from service users treated between August 2014 and August 2017 were collected as part of an NIMH-funded RCT of Person-Centered Care Planning. Data were assessed from 774 charts collected across 14 sites nested within ten community mental health centers (CMHCs). Mixed effects logistic regression models examined direct and interaction effects related to receipt of a benzodiazepine. Results: Of the 774 service users, 19.9% (N = 154) were prescribed at least one benzodiazepine. Of those prescribed a benzodiazepine, 35.1% (N = 54) had a co-occurring SUD and 31.8% (N = 49) had an anxiety disorder. Our main effects model did not find a significant difference in the odds of receiving a benzodiazepine among service users with and without a co-occurring SUD (OR = 0.77, CI: 0.50–1.17). However, moderation analyses found that the odds of being prescribed a benzodiazepine among people with co-occurring SUDs was greater among service users of older age (OR: 2.01, CI: 1.01–4.02) and non-Hispanic white race (OR = 3.34, CI: 1.55–7.22). Discussion: Our findings demonstrate that a considerable number of people with a documented co-occurring SUD are prescribed benzodiazepines in CMHCs, a practice that poses risks for dependence and overdose. Prescribing decisions may be influenced by service user age and race.
AB - Objective: One class of drugs increasingly involved in overdose fatalities is benzodiazepines. Prescribing benzodiazepines to people with co-occurring substance use disorders (SUDs) poses risk for overdose and dependence and is not recommended. The current study reports prevalence rates of prescribing benzodiazepines to people with and without co-occurring SUDs in community mental health settings. Clinical and socio-demographic factors associated with receipt of a benzodiazepine were examined, including whether factors potentially indicative of prescribing biases (older age and race) moderated the relationship between having a co-occurring SUD and receiving a benzodiazepine prescription. Methods: Retrospective chart review data from service users treated between August 2014 and August 2017 were collected as part of an NIMH-funded RCT of Person-Centered Care Planning. Data were assessed from 774 charts collected across 14 sites nested within ten community mental health centers (CMHCs). Mixed effects logistic regression models examined direct and interaction effects related to receipt of a benzodiazepine. Results: Of the 774 service users, 19.9% (N = 154) were prescribed at least one benzodiazepine. Of those prescribed a benzodiazepine, 35.1% (N = 54) had a co-occurring SUD and 31.8% (N = 49) had an anxiety disorder. Our main effects model did not find a significant difference in the odds of receiving a benzodiazepine among service users with and without a co-occurring SUD (OR = 0.77, CI: 0.50–1.17). However, moderation analyses found that the odds of being prescribed a benzodiazepine among people with co-occurring SUDs was greater among service users of older age (OR: 2.01, CI: 1.01–4.02) and non-Hispanic white race (OR = 3.34, CI: 1.55–7.22). Discussion: Our findings demonstrate that a considerable number of people with a documented co-occurring SUD are prescribed benzodiazepines in CMHCs, a practice that poses risks for dependence and overdose. Prescribing decisions may be influenced by service user age and race.
KW - Co-occurring disorders
KW - Community mental health
KW - Integrated treatment
KW - Overdose prevention
KW - Prescription drug use
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U2 - 10.1016/j.jsat.2019.10.001
DO - 10.1016/j.jsat.2019.10.001
M3 - Article
C2 - 31856952
AN - SCOPUS:85075191211
SN - 0740-5472
VL - 109
SP - 56
EP - 60
JO - Journal of Substance Abuse Treatment
JF - Journal of Substance Abuse Treatment
ER -