Concurrent prescribing of opioids with other sedating medications after cancer diagnosis: a population-level analysis

Purpose Cancer is a major reason for concurrent prescription of opioids with other sedating medications—particularly benzodiazepines and gabapentinoids—yet population-based assessments of the extent and predictors of concurrent prescribing among clinically and demographically diverse patients with cancer are lacking. Methods We conducted a retrospective cohort study of patients with non-metastatic cancer using North Carolina cancer registry data linked with Medicare and private insurance claims (2013–2016). We used modified Poisson regression to assess associations of patient characteristic with adjusted relative risk (aRR) of new concurrent prescribing of opioids with benzodiazepines or gabapentinoids after diagnosis. Results Overall, 15% of patients were concurrently prescribed opioids with benzodiazepines or gabapentinoids. Characteristics independently associated with an increased risk of concurrent prescribing included cancer type (e.g., aRR cervical vs. colorectal cancer: 1.55, 95% CI: 1.12–2.14); prior use of opioids (aRR: 2.43, 95% CI:2.21–2.67), benzodiazepines (aRR: 4.08, 95% CI: 3.72–4.48), or gabapentinoids (3.82, 95% CI: 3.31–4.39), and premorbid mental health conditions, including substance use disorder (aRR: 1.27, 95% CI: 1.05–1.54). Black and Hispanic patients were less likely to experience concurrent prescribing (aRR, Black vs. White: 0.35, 95% CI: 0.15–0.83; aRR, Hispanic vs. White: 0.75, 95% CI: 0.66–0.85). Conclusion Approximately 1 in 7 patients with cancer was concurrently prescribed opioids with other sedating medications. Associations between patient characteristics and risk of concurrent prescribing highlight predictors of concurrent prescribing and suggest a rationale for systematic assessment of substance use history at diagnosis. Future research could explore inequitable pain and symptom management and investigate risk of adverse medication-related events.