Factors associated with benzodiazepine prescribing in community mental health settings

Lauren Jessell, Victoria Stanhope, Jennifer I. Manuel, Pedro Mateu-Gelabert

    Research output: Contribution to journalArticle

    Abstract

    Objective: One class of drugs increasingly involved in overdose fatalities is benzodiazepines. Prescribing benzodiazepines to people with co-occurring substance use disorders (SUDs) poses risk for overdose and dependence and is not recommended. The current study reports prevalence rates of prescribing benzodiazepines to people with and without co-occurring SUDs in community mental health settings. Clinical and socio-demographic factors associated with receipt of a benzodiazepine were examined, including whether factors potentially indicative of prescribing biases (older age and race) moderated the relationship between having a co-occurring SUD and receiving a benzodiazepine prescription. Methods: Retrospective chart review data from service users treated between August 2014 and August 2017 were collected as part of an NIMH-funded RCT of Person-Centered Care Planning. Data were assessed from 774 charts collected across 14 sites nested within ten community mental health centers (CMHCs). Mixed effects logistic regression models examined direct and interaction effects related to receipt of a benzodiazepine. Results: Of the 774 service users, 19.9% (N = 154) were prescribed at least one benzodiazepine. Of those prescribed a benzodiazepine, 35.1% (N = 54) had a co-occurring SUD and 31.8% (N = 49) had an anxiety disorder. Our main effects model did not find a significant difference in the odds of receiving a benzodiazepine among service users with and without a co-occurring SUD (OR = 0.77, CI: 0.50–1.17). However, moderation analyses found that the odds of being prescribed a benzodiazepine among people with co-occurring SUDs was greater among service users of older age (OR: 2.01, CI: 1.01–4.02) and non-Hispanic white race (OR = 3.34, CI: 1.55–7.22). Discussion: Our findings demonstrate that a considerable number of people with a documented co-occurring SUD are prescribed benzodiazepines in CMHCs, a practice that poses risks for dependence and overdose. Prescribing decisions may be influenced by service user age and race.

    Original languageEnglish (US)
    Pages (from-to)56-60
    Number of pages5
    JournalJournal of Substance Abuse Treatment
    Volume109
    DOIs
    StatePublished - Feb 2020

    Fingerprint

    Benzodiazepines
    Mental Health
    Substance-Related Disorders
    Community Mental Health Centers
    Logistic Models
    National Institute of Mental Health (U.S.)
    Anxiety Disorders
    Prescriptions
    Cross-Sectional Studies
    Demography

    Keywords

    • Co-occurring disorders
    • Community mental health
    • Integrated treatment
    • Overdose prevention
    • Prescription drug use

    ASJC Scopus subject areas

    • Phychiatric Mental Health
    • Medicine (miscellaneous)
    • Clinical Psychology
    • Psychiatry and Mental health

    Cite this

    Factors associated with benzodiazepine prescribing in community mental health settings. / Jessell, Lauren; Stanhope, Victoria; Manuel, Jennifer I.; Mateu-Gelabert, Pedro.

    In: Journal of Substance Abuse Treatment, Vol. 109, 02.2020, p. 56-60.

    Research output: Contribution to journalArticle

    Jessell, Lauren ; Stanhope, Victoria ; Manuel, Jennifer I. ; Mateu-Gelabert, Pedro. / Factors associated with benzodiazepine prescribing in community mental health settings. In: Journal of Substance Abuse Treatment. 2020 ; Vol. 109. pp. 56-60.
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    AB - Objective: One class of drugs increasingly involved in overdose fatalities is benzodiazepines. Prescribing benzodiazepines to people with co-occurring substance use disorders (SUDs) poses risk for overdose and dependence and is not recommended. The current study reports prevalence rates of prescribing benzodiazepines to people with and without co-occurring SUDs in community mental health settings. Clinical and socio-demographic factors associated with receipt of a benzodiazepine were examined, including whether factors potentially indicative of prescribing biases (older age and race) moderated the relationship between having a co-occurring SUD and receiving a benzodiazepine prescription. Methods: Retrospective chart review data from service users treated between August 2014 and August 2017 were collected as part of an NIMH-funded RCT of Person-Centered Care Planning. Data were assessed from 774 charts collected across 14 sites nested within ten community mental health centers (CMHCs). Mixed effects logistic regression models examined direct and interaction effects related to receipt of a benzodiazepine. Results: Of the 774 service users, 19.9% (N = 154) were prescribed at least one benzodiazepine. Of those prescribed a benzodiazepine, 35.1% (N = 54) had a co-occurring SUD and 31.8% (N = 49) had an anxiety disorder. Our main effects model did not find a significant difference in the odds of receiving a benzodiazepine among service users with and without a co-occurring SUD (OR = 0.77, CI: 0.50–1.17). However, moderation analyses found that the odds of being prescribed a benzodiazepine among people with co-occurring SUDs was greater among service users of older age (OR: 2.01, CI: 1.01–4.02) and non-Hispanic white race (OR = 3.34, CI: 1.55–7.22). Discussion: Our findings demonstrate that a considerable number of people with a documented co-occurring SUD are prescribed benzodiazepines in CMHCs, a practice that poses risks for dependence and overdose. Prescribing decisions may be influenced by service user age and race.

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