Association of combination opioid, benzodiazepine, and muscle relaxant usage with emergency department visits in a nationwide cohort in the United States.

Background Concurrent opioid and benzodiazepine use ("double-threat") and opioid, benzodiazepine, and muscle relaxant use ("triple-threat") are linked to increased adverse events compared to opioid use alone. Objectives To assess prevalence of double-threat and triple-threat in the US and to measure association between double- and triple-threat and emergency department visits. Setting Nationally representative, 2-year health database of the United States. Method A retrospective cohort study was conducted using the national medical expenditure panel survey. Two-year prevalence of combination use was measured. Association between 2013-2014 double- and triple-threat exposure and emergency department visit compared to non-users, opioid-users, and all other exposure combinations assessed using logistic regression. Main outcome measures Survey-weighted prevalence of triple-threat and double-threat in 2013 and 2014 was measured. The outcome variable of at least one emergency department visit in a study year was utilized for the logistic regression. Results Opioids, benzodiazepines, and muscle relaxants were used in 11.9% (38.4 million lives), 4.2% (13.5 million), and 3.4% (10.9 million) individuals respectively in 2013, and 12.2% (39.3 million), 4.6% (14.8 million), and 3.6% (11.6 million), respectively in 2014. Prevalence of individuals on double-threat rose from 1.6 to 1.9% from 2013 to 2014. Triple-threat prevalence was unchanged at 0.53% in that interval. Triple-threat patients had increased emergency department visit probability with ORs of 9.19 (95% CI 9.17-9.22) in 2013, 9.82 (95% CI 9.79-9.85) in 2014, and 5.90 (95% CI 5.89-5.92) for longitudinal 2013-2014 analysis compared to non-users. Double-threat patients had increased emergency department visit probability with ORs of 4.57 (95% CI 4.56-4.58) in 2013, 6.66 (95% CI 6.65-6.68) in 2014, and 4.49 (95% CI 4.48-4.50) for 2013-2014 analysis compared to non-users. Conclusions Concurrent opioid and benzodiazepine use and opioid, benzodiazepine, and muscle relaxant use increased probability of emergency department visit. Amplified efforts in surveillance, prescribing, and default follow-up for concurrent opioid, benzodiazepine, muscle relaxant use are needed to reduce this public health concern.

Association of increased emergency rooms costs for patients without access to necessary medications.

BACKGROUND: Prescription medications are an important component of chronic disease management. They are vital in preventing unnecessary ER visits. However, few studies have examined the association between patients' self-reported inability to receive necessary medications and emergency room costs. OBJECTIVES: The study objectives were to: 1) determine differences in ER costs based on self-reported ability to obtain necessary medications. 2) identify differences in ER costs based on self-reported ability to obtain necessary medications among medication users. The association was also examined by insurance category. METHODS: Respondent data from 10 years (2002-2011) of the U.S. Medical Expenditure Panel Survey was analyzed. The models employed estimated the association of respondents reporting being 'unable to receive necessary medications' on ER expenditures. Secondarily, the relationship was assessed by insurance category: private, public, and uninsured. Two-part cost regression models with bootstrapped estimates to produce 95% confidence intervals of cost differences were applied for these analyses. Significance was set at α = 0.05. Analyses were completed using SAS 9.4 (Cary, NC) and Stata 13 (College Station, TX). Estimates were in 2011 US dollars. RESULTS: People unable to receive necessary medications experienced increased average annual ER costs of $46.62 with 95% a confidence interval [CI] of 34.76-58.49) compared to patients able to receive necessary medications. By insurance category, respondents unable to receive necessary medications experienced increased ER costs of $104.80 (95% CI: 60.57-149.03), $42.16 (95% CI: 24.65-59.68), and $33.18 (95% CI: 18.54-47.82), for Publically Insured, Privately Insured, and Uninsured, respectively. Findings were similar for those already using medications. CONCLUSIONS: Inability to obtain necessary medications is associated with increased emergency room costs. Those with public insurance have a larger increase in ER costs if they are without necessary medications compared to those insured privately or without insurance.