Reducing coprescriptions of benzodiazepines and opioids in a veteran population

Combination opioid and benzodiazepine (BZD) therapy is associated with poor treatment outcomes and increased risk of overdose death. There is currently limited literature detailing well-implemented strategies to minimize dual prescribing of these agents. The following describes the implementation processes and outcomes of a health system quality improvement project that aimed to reduce combination BZD and opioid therapy.

A retrospective chart review-based quality improvement project.

All patients within a single healthcare system of the Department of Veterans Affairs treated with long-term (>90 days) combination therapy were identified. A psychiatric pharmacist submitted a 1-time chart review note for each patient, which briefly outlined patient-specific considerations and recommendations for alternatives to BZD treatment. After a 30-day period following entry of the chart review notes, data were collected regarding the number of providers who (1) acknowledged the chart review notes by providing their additional signature and (2) committed to the recommended interventions by initiating taper schedules.

During the 30-day follow-up period, 47.5% (n = 29) of chart review notes were acknowledged and 11.5% (n = 7) of prescriptions were tapered by providers. Mental health providers were less likely to provide their additional signature to the chart review notes (χ2 = 4.62, df = 1, P = .0316; Fisher exact test, P = .0215) and to initiate taper schedules (χ2 = 5.51, df = 1, P = .0189; Fisher exact test, P = .0410) compared with primary care providers.

Chart review note recommendations were frequently disregarded by providers and are likely insufficient as a primary intervention tool for reducing long-term combination BZD and opioid therapy.