Prescription Patterns of Benzodiazepines and Opioid Analgesics in Adults with and without Major Psychiatric...

Using a time-lagged cohort design with temporal separation, we aimed to compare the prescribing patterns of benzodiazepine receptor agonists (BZRAs) and opioid analgesics between adults with and without major psychiatric disorders (PYs).

This retrospective nationwide longitudinal cohort study used South Korea's National Health Insurance Service database. Major PYs and covariates were identified during 2021 (exposure period). A time-lagged design was employed in which prescribing outcomes were tracked throughout 2022 to ensure temporal separation and precedence. After 1:1 propensity score matching, 570088 individuals (285044 per group) were included. Regular and continuous prescription was defined as ≥90 days of cumulative supply. Concurrent prescription was defined as ≥7 days of overlapping prescriptions.

After matching, opioid analgesic prescription occurred in 21.9% of psychiatric patients versus 21.5% of controls [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01 to 1.03; p=0.001]. BZRA prescription showed a significant disparity (37.0% vs. 18.2%; OR 2.64, 95% CI 2.61 to 2.67). Concurrent prescription was observed in 48.2% of psychiatric patients compared with 33.6% of controls (OR 1.84, 95% CI 1.82 to 1.86). Notably, in a sensitivity analysis restricted to BZRA users, the association with subsequent opioid prescription was not statistically significant (OR 1.01, p=0.438), suggesting that high baseline BZRA exposure largely drives concurrent prescribing patterns.

Adults with major PYs were more likely to receive long-term and overlapping prescriptions for BZRAs and opioid analgesics. Despite modest opioid increases, high concurrent prescribing-largely driven by baseline BZRA use-remains a significant safety concern requiring integrated monitoring.