Conference Coverage

High rates of prescription opioid, benzodiazepine use observed in chronic liver disease


 

REPORTING FROM THE LIVER MEETING 2018

Patients with chronic liver disease are prescribed opioids and benzodiazepines at very high rates, despite risk for adverse consequences because of hepatic metabolism, according to results from a large longitudinal study of national data.

Dr. Monica Konerman of the University of Michigan NAFLD Clinic

Dr. Monica Konerman

“Middle-aged individuals and those with a background of substance abuse and mental health conditions appear to have highest rates of use and represent populations for which targeted interventions to curb use could be highest yield,” lead study author Monica Konerman, MD, said in an interview in advance of the annual meeting of the American Association for the Study of Liver Diseases.

In an effort to better understand the rates of prescription opioid and benzodiazepine use in chronic liver disease, Dr. Konerman, director of the Michigan Medicine NAFLD Clinic at the University of Michigan, Ann Arbor, and her colleagues drew from the Truven Health Analytics Marketscan databases from 2009 to 2015. They limited the analysis to individuals with drug coverage who had chronic hepatitis C (HCV) without cirrhosis, cirrhosis, congestive heart failure (CHF), or chronic obstructive pulmonary disease (COPD), and examined pharmacy files for outpatient prescriptions.

Dr. Konerman reported data from 210,191 patients with HCV, 79,332 with cirrhosis, 766,840 with CHF, and 1,438,798 with COPD. Their median age was 59 years, and 51% were female. In per person-years, the prevalence of prescription opioid use was 25% among patients with chronic HCV, 53% among patients with cirrhosis, 26% among those with CHF, and 24% among those with COPD. At the same time, in per person-years, the prevalence of benzodiazepine use was 12% among patients with chronic HCV, 21% among patients with cirrhosis, 12% among those with CHF, and 13% among those with COPD. Use of opioids was greatest in adults 40-59 years of age (P less than .001). High-dose opioid use, defined as 100 opioid morphine equivalents per day or greater, occurred in 23% of those with cirrhosis and in 22% of those with HCV.

“The significant increase in rates of use in chronic liver disease, compared to other chronic conditions was remarkable, particularly given that patients with liver disease are at higher risk for adverse consequences of use due to hepatic metabolism of these medications,” Dr. Konerman said.

She went on to acknowledge “inherent limitations to studies that are secondary database analyses that rely on diagnosis codes for categorization of disease with potential for both over and under classification. We also did not capture inpatient prescriptions,” she said.

Dr. Konerman reported having no financial disclosures.

Recommended Reading

Black patients present as sicker, more likely to receive liver transplant
MDedge Internal Medicine
Aspirin cuts risk of ovarian and liver cancer
MDedge Internal Medicine
Novel score predicts esophageal varices in patients with cirrhosis prior to EGD
MDedge Internal Medicine
HCV adapts to HIV coinfection
MDedge Internal Medicine
HCV, HBV, and HIV associated with autoimmune kidney diseases
MDedge Internal Medicine
Maintaining virologic response predicted long-term survival in HBV patients with decompensated cirrhosis
MDedge Internal Medicine
ACIP votes unanimously in favor of immunization schedule update and redesign
MDedge Internal Medicine
Norfloxacin might benefit patients with advanced cirrhosis and low ascites fluid protein levels
MDedge Internal Medicine
U.S. death rates from chronic liver disease continue to rise
MDedge Internal Medicine
Good news, bad news about HCV in kidney disease
MDedge Internal Medicine