{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:08:01Z","timestamp":1790784481397,"version":"4.1.0"},"reference-count":37,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:00:00Z","timestamp":1637107200000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"crossref","award":["RO1-DA039192"],"award-info":[{"award-number":["RO1-DA039192"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,10,25]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Opioid and benzodiazepine co-prescribing is associated with a substantial increase in opioid overdose deaths. In this study, we examine the prescribing trends of substitutes of opioids and benzodiazepines alone or in combination, compared with opioids and benzodiazepines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Data were collected using a 20% national sample of Medicare beneficiaries from 2013 to 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>4.1\u20134.3\u2009million enrollees each year from 2013 to 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome<\/jats:title>\n                    <jats:p>We employ a generalised linear mixed models to calculate ORs for opioid use, benzodiazepine or Z-drug (benzos\/Z-drugs) use, opioid\/benzos\/Z-drugs 30-day use, gabapentinoid use and (selective serotonin reuptake inhibitors (SSRI) and serotonin norepinephrine reuptake inhibitors (SNRIs)) use, adjusted for the repeated measure of patient. We then created two models to calculate the ORs for each year and comparing to 2013.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Opioid and benzos\/Z-drugs use decreased by 2018 (aOR 0.626; 95%\u2009CI 0.622 to 0.630) comparing to 2013. We demonstrate a 36.3% and 9.9% increase rate of gabapentinoid and SSRI\/SNRI use, respectively. Furthermore, combined gabapentinoid and SSRI\/SNRI use increased in 2018 (aOR 1.422; 95%\u2009CI 1.412 to 1.431).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Little is known about the prescribing pattern and trend of opioid and benzodiazepine alternatives as analgesics. There is a modest shift from prescribing opioid and benzos\/Z-drugs (alone or in combination) towards prescribing non-opioid analgesics\u2014gabapentinoids with and without non-benzos\/Z-drugs that are indicated for anxiety. It is unclear if this trend towards opioid\/benzos\/Z-drugs alternatives is associated with fewer drug overdose death, better control of pain and comorbid anxiety, and improved quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-053487","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T11:50:40Z","timestamp":1637236240000},"page":"e053487","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["Trends in prescribing pattern of opioid and benzodiazepine substitutes among Medicare part D beneficiaries from 2013 to 2018: a retrospective study"],"prefix":"10.1136","volume":"11","author":[{"given":"Aimalohi","family":"Esechie","sequence":"first","affiliation":[{"name":"Neurology, The University of Texas Medical Branch, Galveston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Fang","family":"Kuo","sequence":"additional","affiliation":[{"name":"Division of Geriatrics and Palliative Medicine & Sealy Center on Aging, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S","family":"Goodwin","sequence":"additional","affiliation":[{"name":"Division of Geriatrics and Palliative Medicine & Sealy Center on Aging, Department of Internal Medicine, Department of Preventive Medicine and Population Health, Institute for Translational Science, The University of Texas Medical Branch, Galveston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Westra","sequence":"additional","affiliation":[{"name":"Office of Biostatistics, The University of Texas Medical Branch, Galveston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7460-7281","authenticated-orcid":false,"given":"Mukaila A","family":"Raji","sequence":"additional","affiliation":[{"name":"Department of Neurology, Division of Geriatrics and Palliative Medicine & Sealy Center on Aging, Department of Internal Medicine, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,11,18]]},"reference":[{"key":"2025121409051928000_11.11.e053487.1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6911a4"},{"key":"2025121409051928000_11.11.e053487.2","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1001\/jamainternmed.2015.7799","article-title":"Effect of US drug enforcement administration's rescheduling of hydrocodone combination analgesic products on opioid analgesic prescribing","volume":"176","author":"Jones","year":"2016","journal-title":"JAMA Intern Med"},{"key":"2025121409051928000_11.11.e053487.3","first-page":"1","article-title":"2016: summary of constituent comments and CDC response","volume":"65","year":"2016","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025121409051928000_11.11.e053487.4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.1464"},{"key":"2025121409051928000_11.11.e053487.5","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6904a1"},{"key":"2025121409051928000_11.11.e053487.6","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6626a4"},{"key":"2025121409051928000_11.11.e053487.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1807069"},{"key":"2025121409051928000_11.11.e053487.8","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00783"},{"key":"2025121409051928000_11.11.e053487.9","doi-asserted-by":"crossref","unstructured":"Peahl AF , Dalton VK , Montgomery JR . 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