{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:56:31Z","timestamp":1791428191675,"version":"4.3.3"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Opioid and benzodiazepine use by older adults is related to increased fall risk.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate whether a centralized consultant pharmacist intervention increases opioid and benzodiazepine deprescribing and reduces falls among older adults in primary care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This intention-to-treat cluster randomized trial with 1-year follow-up included 2075 adults 65 years or older with long-term opioid use (n\u2009=\u2009965) or benzodiazepine use (n\u2009=\u20091110) identified from electronic health record prescription data with a clinic visit from June 1, 2020, to July 31, 2022. Patients were from primary care clinics in the University of North Carolina Health Physician Network without embedded pharmacists, all using a shared electronic health record (EHR). Exclusions included active cancer treatment, dementia, or non\u2013English-language preference. Statistical analysis was performed in November 2022.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Clinics were randomized to a centralized consultant pharmacist service or usual care. Pharmacists reviewed the EHR and the state\u2019s prescription drug monitoring program and then provided patient-specific opioid or benzodiazepine tapering recommendations for prescribers at intervention clinics. Control clinics received no deprescribing support.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n Primary outcomes were average daily morphine milligram equivalents (MMEs) and diazepam milligram equivalents (DMEs) ordered in the year after the index visit. Secondary outcomes included medication discontinuation (\u2265180-day gap in orders) and incident falls identified using\n International Classification of Diseases, Ninth Revision (ICD-9)<\/jats:italic>\n or\n International Statistical Classification of Diseases<\/jats:italic>\n and\n Related Health Problems, Tenth Revision (ICD-10)<\/jats:italic>\n codes.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 2075 patients (mean [SD] age, 74.6 [0.13 for opioid group and 0.15 for benzodiazepine group] years; 1429 [68.9%] female) met criteria for long-term opioid or benzodiazepine use. Both intervention and control clinics showed reductions in opioid and benzodiazepine exposure, but between-group differences were not statistically significant. Mean (SD) daily MMEs decreased by 8.8% in intervention clinics (26.9 [54.2] to 24.5 [50.4]) and 5.4% in controls (18.7 [33.4] to 17.6 [32.0]) (\n P<\/jats:italic>\n \u2009=\u2009.71); mean (SD) DMEs decreased by 11.4% (8.8 [10.4] to 7.8 [10.1]) and 1.5% (6.6 [8.2] to 6.5 [8.3]), respectively (\n P<\/jats:italic>\n \u2009=\u2009.07). Although the proportion of patients who discontinued opioids was 21.4% in intervention clinics and 19.9% in control clinicals, this difference was not statistically significant (odds ratio [OR], 1.20; 95% CI, 0.85-1.71). The proportion of patients who discontinued benzodiazepines was 22.0% in intervention clinics and 18.4% in control clinics. This difference was not statistically significant (OR, 1.41; 95% CI, 0.94-2.03). There was no difference in the likelihood of incident falls between patients taking opioids in the control and intervention clinics (OR, 1.36; 95% CI, 0.94-1.96). In subgroup analyses, patients taking benzodiazepines with less than 10 daily DMEs had significantly reduced DMEs (effect size, \u22120.22; 95% CI, \u22120.36 to \u22120.08;\n P<\/jats:italic>\n \u2009=\u2009.002).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This cluster randomized trial found that a centralized consultant pharmacist model was feasible, integrated well into primary care workflows, and resulted in high practitioner acceptance of recommendations; however, it did not significantly reduce opioid or benzodiazepine prescribing or falls within 1 year. These results suggest that more intensive or sustained deprescribing strategies may be needed to produce clinically meaningful reductions in high-risk medication use among older adults in primary care clinics.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04272671<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.60581","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T16:30:36Z","timestamp":1772123436000},"page":"e2560581","source":"Crossref","is-referenced-by-count":3,"title":["A Pharmacist Consultant Service for Deprescribing Opioids and Benzodiazepines in Older Adults"],"prefix":"10.1001","volume":"9","author":[{"given":"Jan","family":"Busby-Whitehead","sequence":"first","affiliation":[{"name":"Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill"},{"name":"UNC Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie P.","family":"Ferreri","sequence":"additional","affiliation":[{"name":"Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Niznik","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill"},{"name":"UNC Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill"},{"name":"Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill"},{"name":"Now with Chiesi, USA, Cary, North Carolina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori T.","family":"Armistead","sequence":"additional","affiliation":[{"name":"Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamera","family":"Hughes","sequence":"additional","affiliation":[{"name":"Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill"},{"name":"Now with Fred Wilson School of Pharmacy, High Point University, High Point, North Carolina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill"},{"name":"Department of Pharmacy Analytics, UNC Health, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin Y.","family":"Urick","sequence":"additional","affiliation":[{"name":"Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill"},{"name":"Prime Therapeutics, Eagan, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S.","family":"Preisser","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Larson","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill"},{"name":"UNC Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Roberts","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill"},{"name":"UNC Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leigh","family":"Foushee","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, UNC Health, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara","family":"Haddad","sequence":"additional","affiliation":[{"name":"National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"zoi251622r1","article-title":"Epidemiology of mortality attributed to falls in older adults in the US, 1999-2020.","author":"Crane","year":"2023","journal-title":"J Am Geriatr Soc"},{"issue":"4","key":"zoi251622r2","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1111\/bcp.12386","article-title":"Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process.","volume":"78","author":"Reeve","year":"2014","journal-title":"Br J Clin Pharmacol"},{"issue":"5","key":"zoi251622r3","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1001\/jamainternmed.2015.0324","article-title":"Reducing inappropriate polypharmacy: the process of deprescribing.","volume":"175","author":"Scott","year":"2015","journal-title":"JAMA Intern Med"},{"issue":"7","key":"zoi251622r4","doi-asserted-by":"publisher","first-page":"2052","DOI":"10.1111\/jgs.18372","article-title":"American Geriatrics Society 2023 updated AGS Beers Criteria\u00ae for potentially inappropriate medication use in older adults.","volume":"71","author":"By the 2023 American Geriatrics Society Beers Criteria\u00ae Update Expert Panel","year":"2023","journal-title":"J Am Geriatr Soc"},{"issue":"1","key":"zoi251622r6","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1177\/0897190013515001","article-title":"Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics.","volume":"27","author":"Jann","year":"2014","journal-title":"J Pharm Pract"},{"issue":"14","key":"zoi251622r7","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1001\/archinte.164.14.1567","article-title":"Benzodiazepine use and hip fractures in the elderly: who is at greatest risk?","volume":"164","author":"Wagner","year":"2004","journal-title":"Arch Intern Med"},{"issue":"3","key":"zoi251622r8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7103a1","article-title":"CDC clinical practice guideline for prescribing opioids for pain - United States, 2022.","volume":"71","author":"Dowell","year":"2022","journal-title":"MMWR Recomm Rep"},{"issue":"21","key":"zoi251622r9","doi-asserted-by":"publisher","first-page":"1952","DOI":"10.1001\/archinternmed.2009.357","article-title":"Meta-analysis of the impact of 9 medication classes on falls in elderly persons.","volume":"169","author":"Woolcott","year":"2009","journal-title":"Arch Intern Med"},{"key":"zoi251622r10","doi-asserted-by":"publisher","first-page":"413","DOI":"10.2147\/CEOR.S406137","article-title":"Benzodiazepine usage, healthcare resource utilization, and costs among older adults treated with common insomnia medications: a retrospective cohort study.","volume":"15","author":"Wickwire","year":"2023","journal-title":"Clinicoecon Outcomes Res"},{"issue":"1","key":"zoi251622r11","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1186\/s12877-022-03165-6","article-title":"Falls, healthcare resources and costs in older adults with insomnia treated with zolpidem, trazodone, or benzodiazepines.","volume":"22","author":"Amari","year":"2022","journal-title":"BMC Geriatr"},{"issue":"35","key":"zoi251622r12","doi-asserted-by":"publisher","first-page":"938","DOI":"10.15585\/mmwr.mm7235a1","article-title":"Nonfatal and fatal falls among adults aged =65 years - United States, 2020-2021.","volume":"72","author":"Kakara","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"6","key":"zoi251622r14","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1016\/j.mayocp.2015.04.003","article-title":"Tapering long-term opioid therapy in chronic noncancer pain: evidence and recommendations for everyday practice.","volume":"90","author":"Berna","year":"2015","journal-title":"Mayo Clin Proc"},{"issue":"1","key":"zoi251622r15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0227696","article-title":"Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: conditional effect of age.","volume":"15","author":"Cordovilla-Guardia","year":"2020","journal-title":"PLoS One"},{"issue":"6","key":"zoi251622r16","doi-asserted-by":"publisher","first-page":"1210","DOI":"10.1111\/jgs.14133","article-title":"Interventions to address potentially inappropriate prescribing in community-dwelling older adults: a systematic review of randomized controlled trials.","volume":"64","author":"Clyne","year":"2016","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"zoi251622r17","doi-asserted-by":"publisher","DOI":"10.1093\/geroni\/igx028","article-title":"Implementing STEADI in academic primary care to address older adult fall risk.","volume":"1","author":"Eckstrom","year":"2017","journal-title":"Innov Aging"},{"issue":"3","key":"zoi251622r18","doi-asserted-by":"publisher","DOI":"10.3390\/pharmacy7030113","article-title":"Training and toolkit resources to support implementation of a community pharmacy fall prevention service.","volume":"7","author":"Robinson","year":"2019","journal-title":"Pharmacy (Basel)"},{"key":"zoi251622r19","doi-asserted-by":"publisher","first-page":"1778","DOI":"10.1111\/jgs.16459","article-title":"Impact of STEADI-Rx: a community pharmacy-based fall prevention intervention.","volume":"68","author":"Blalock","year":"2020","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"zoi251622r20","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1056\/NEJMoa2002183","article-title":"A randomized trial of a multifactorial strategy to prevent serious fall injuries.","volume":"383","author":"Bhasin","year":"2020","journal-title":"N Engl J Med"},{"issue":"9","key":"zoi251622r21","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1007\/s40266-022-00967-6","article-title":"Primary-care prescribers\u2019 perspectives on deprescribing opioids and benzodiazepines in older adults.","volume":"39","author":"Niznik","year":"2022","journal-title":"Drugs Aging"},{"issue":"19","key":"zoi251622r22","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcsop.2025.100627","article-title":"Building primary care providers\u2019 confidence in deprescribing opioids and benzodiazepines in older adults.","volume":"19","author":"Ferreri","year":"2025","journal-title":"Explor Res Clin Soc Pharm"},{"key":"zoi251622r23","article-title":"Pharmacist interventions to deprescribe opioids and benzodiazepines in older adults: a rapid review.","author":"Niznik","year":"2021","journal-title":"Res Social Adm Pharm"},{"key":"zoi251622r24","author":"Armistead","year":"2021","journal-title":"J Am Pharm Assoc (2003)"},{"issue":"8","key":"zoi251622r25","doi-asserted-by":"publisher","first-page":"3358","DOI":"10.1016\/j.sapharm.2021.11.013","article-title":"A-TAPER: a framework for deprescribing medications effectively.","volume":"18","author":"Armistead","year":"2022","journal-title":"Res Social Adm Pharm"},{"issue":"1","key":"zoi251622r26","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1186\/s13063-022-06164-5","article-title":"A deprescribing medication program to evaluate falls in older adults: methods for a randomized pragmatic clinical trial.","volume":"23","author":"Niznik","year":"2022","journal-title":"Trials"},{"issue":"2","key":"zoi251622r28","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooad034","article-title":"An EHR-based method to structure, standardize, and automate clinical documentation tasks for pharmacists to generate extractable outcomes.","volume":"6","author":"Sanders","year":"2023","journal-title":"JAMIA Open"},{"key":"zoi251622r29","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1111\/jgs.16825","article-title":"Benzodiazepine use among Medicare, commercially insured, and veteran older adults, 2013\u20132017.","volume":"69","author":"Maust","year":"2021","journal-title":"J Am Geriatr Soc"},{"issue":"5","key":"zoi251622r30","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1097\/MLR.0000000000000505","article-title":"A detailed exploration into the association of prescribed opioid dosage and overdose deaths among patients with chronic pain.","volume":"54","author":"Bohnert","year":"2016","journal-title":"Med Care"},{"issue":"4","key":"zoi251622r31","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1111\/jgs.15767","article-title":"American Geriatrics Society 2019 Updated AGS Beers Criteria\u00ae for Potentially Inappropriate Medication Use in Older Adults.","volume":"67","author":"2019 American Geriatrics Society Beers Criteria\u00ae Update Expert Panel","year":"2019","journal-title":"J Am Geriatr Soc"},{"key":"zoi251622r33","doi-asserted-by":"publisher","first-page":"h2698","DOI":"10.1136\/bmj.h2698","article-title":"Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study.","volume":"350","author":"Park","year":"2015","journal-title":"BMJ"},{"issue":"6","key":"zoi251622r34","doi-asserted-by":"publisher","first-page":"1944","DOI":"10.1111\/jgs.18288","article-title":"Patterns and disparities in prescribing of opioids and benzodiazepines for older adults in North Carolina.","volume":"71","author":"Niznik","year":"2023","journal-title":"J Am Geriatr Soc"},{"key":"zoi251622r35","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcsop.2023.100267","article-title":"A descriptive analysis of primary care providers\u2019 interest in clinical pharmacy services.","volume":"10","author":"Gutierrez Euceda","year":"2023","journal-title":"Explor Res Clin Soc Pharm"},{"issue":"10","key":"zoi251622r36","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1097\/MLR.0b013e3181e57962","article-title":"US pharmacists\u2019 effect as team members on patient care: systematic review and meta-analyses.","volume":"48","author":"Chisholm-Burns","year":"2010","journal-title":"Med Care"},{"key":"zoi251622r37","first-page":"71","article-title":"Medication therapy management: current challenges.","volume":"9","author":"Ferreri","year":"2020","journal-title":"Integr Pharm Res Pract"},{"issue":"1","key":"zoi251622r38","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/j.japh.2022.09.025","article-title":"Design, implementation, and evaluation of a pharmacist-led outpatient benzodiazepine-tapering clinic.","volume":"63","author":"Gregorian","year":"2023","journal-title":"J Am Pharm Assoc (2003)"},{"issue":"6","key":"zoi251622r39","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1001\/jamainternmed.2014.949","article-title":"Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial.","volume":"174","author":"Tannenbaum","year":"2014","journal-title":"JAMA Intern Med"},{"key":"zoi251622r27","volume-title":"Chronic Condition Data Warehouse Medicare Administrative Data User Guide","year":"2018"},{"key":"zoi251622r32","volume-title":"STEADI-Rx Older Adult Fall Prevention Guide for Community Pharmacists","author":"Ferreri","year":"2020"},{"key":"zoi251622r5","unstructured":"Bruy\u00e8re Research Institute. What is Deprescribing? Published 2019. Accessed December 9, 2024. https:\/\/deprescribing.org\/what-is-deprescribing\/."},{"key":"zoi251622r13","unstructured":"Web-based Injury Statistics Query and Reporting System (WISQARS). Centers for Disease Control and Prevention Nonfatal Injury Data. Published 2017. Accessed March 4, 2024. https:\/\/www.cdc.gov\/injury\/wisqars\/nonfatal.html."}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2845574\/busbywhitehead_2026_oi_251622_1772555983.13989.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T17:04:32Z","timestamp":1772557472000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2845574"}},"subtitle":["A Cluster Randomized Trial"],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":39,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.60581","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]}}}