Benzodiazepine, Z-drug, and sleep medication prescriptions in male and female people with opioid use disorder on buprenorphine and comorbid insomnia: an analysis of multistate insurance claims

Abstract Study Objectives In adult populations, women are more likely than men to be prescribed benzodiazepines. However, such disparities have not been investigated in people with opioid use disorder (OUD) and insomnia receiving buprenorphine, a population with particularly high sedative/hypnotic r...

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Published in:Sleep (New York, N.Y.) N.Y.), 2023-06, Vol.46 (6), p.1
Main Authors: Martin, Caitlin E, Patel, Hetal, Dzierzewski, Joseph M, Moeller, F Gerard, Bierut, Laura J, Grucza, Richard A, Xu, Kevin Y
Format: Article
Language:English
Subjects:
Adult
Analysis
Anesthesia
Benzodiazepines
Benzodiazepines - adverse effects
Buprenorphine
Buprenorphine - therapeutic use
Comorbidity
Female
Females
Gender differences
Humans
Hydroxyzine
Hypnotics and Sedatives - therapeutic use
Insomnia
Insomnia and Psychiatric Disorders
Insurance
Male
Medicaid
Medical research
Medicine, Experimental
Narcotics
Opioid-Related Disorders - epidemiology
Prescription writing
Prescriptions
Retrospective Studies
Sex differences (Psychology)
Sleep
Sleep Initiation and Maintenance Disorders - drug therapy
Substance use disorder
Trazodone
United States
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Summary:Abstract Study Objectives In adult populations, women are more likely than men to be prescribed benzodiazepines. However, such disparities have not been investigated in people with opioid use disorder (OUD) and insomnia receiving buprenorphine, a population with particularly high sedative/hypnotic receipt. This retrospective cohort study used administrative claims data from Merative MarketScan Commercial and MultiState Medicaid Databases (2006–2016) to investigate sex differences in the receipt of insomnia medication prescriptions among patients in OUD treatment with buprenorphine. Methods We included people aged 12–64 years with diagnoses of insomnia and OUD-initiating buprenorphine during the study timeframe. The predictor variable was sex (female versus male). The primary outcome was receipt of insomnia medication prescription within 60 days of buprenorphine start, encompassing benzodiazepines, Z-drugs, or non-sedative/hypnotic insomnia medications (e.g. hydroxyzine, trazodone, and mirtazapine). Associations between sex and benzodiazepine, Z-drug, and other insomnia medication prescription receipt were estimated using Poisson regression models. Results Our sample included 9510 individuals (female n = 4637; male n = 4873) initiating buprenorphine for OUD who also had insomnia, of whom 6569 (69.1%) received benzodiazepines, 3891 (40.9%) Z-drugs, and 8441 (88.8%) non-sedative/hypnotic medications. Poisson regression models, adjusting for sex differences in psychiatric comorbidities, found female sex to be associated with a slightly increased likelihood of prescription receipt: benzodiazepines (risk ratio [RR], RR = 1.17 [1.11–1.23]), Z-drugs (RR = 1.26 [1.18–1.34]), and non-sedative/hypnotic insomnia medication (RR = 1.07, [1.02–1.12]). Conclusions Sleep medications are commonly being prescribed to individuals with insomnia in OUD treatment with buprenorphine, with sex-based disparities indicating a higher prescribing impact among female than male OUD treatment patients. Graphical Abstract Graphical Abstract
ISSN:0161-8105
1550-9109
DOI:10.1093/sleep/zsad083