Reducing concurrent opioid-benzodiazepine prescriptions through provider messages

What was the challenge?

The Department of Veterans Affairs (VA) and the Department of Defense (DoD) Clinical Practice Guideline for Opioid Therapy for Chronic Pain strongly recommends against the concurrent use of opioids and benzodiazepines. The Defense Health Agency (DHA) in the DoD sought to increase adherence to prescribing guidelines by reducing concurrent prescribing of opioids and benzodiazepines.

What was the program change?

OES and DHA designed targeted messages to communicate with providers about the guidelines and to encourage care coordination.

How did the evaluation work?

Patients newly identified as having concurrent opioid-benzodiazepine prescriptions were randomly assigned to one of two provider messaging conditions: no email with as usual access to an existing opioid registry (control), or a group email to all associated providers with encouragement to coordinate across providers.

What was the impact?

There was no statistically significant difference in patients’ total receipt of opioids, total receipt of benzodiazepines, or overlapping days of opioids and benzodiazepines during the 90 days following the email intervention. Following enrollment, average opioid receipt was 21.7 days among control patients and 22.9 days among treated patients; average benzodiazepine receipt was 20.0 days and 19.6 days among control and treated patients, respectively; and the average number of days with overlapping opioids and benzodiazepines was 10.6 and 10.5 among control and treated patients, respectively.

Related publications: Sacarny A, Safran E, Steffel M, et al. Effect of Pharmacist Email Alerts on Concurrent Prescribing of Opioids and Benzodiazepines by Prescribers and Primary Care Managers: A Randomized Clinical Trial. JAMA Health Forum. 2022;3(9):e223378.

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