Assessing Concurrent Use of Opioids and Benzodiazepines Using Urine Drug Test Results

The purpose of this dissertation was to assess concurrent use of benzodiazepines and opioids, using laboratory results from urine toxicology records. The opioid crisis is an ongoing public health issue that has spanned over two decades. Drug overdose death is now the leading cause of accidental deaths among American adults. Patients who take benzodiazepines and opioids concurrently are at even greater risk of overdose than those taking an opioid alone. Prominent agencies including the Centers for Disease Control and Prevention, Food and Drug Administration and the Centers for Medicare and Medicaid Services strongly recommend against co-prescribing opioids and benzodiazepines when possible, and the use of urine drug testing to mitigate patient risks through monitoring and early intervention. Although there have been studies on co-prescribing rates using prescription data, there is little evidence on the rates of patient drug use using UDT data. This dissertation used large, population-based administrative data to address the following research gaps using patient urine drug test (UDT) results: 1) examine trends in concurrent opioid and benzodiazepine use among adult patients and assess whether there was a shift from prescribed to illicit or non-prescribed drug use; 2) determine patient characteristics associated with aberrant UDT results—concurrent use, illicit drug use or non-prescribed use; 3) assess provider response to concurrent use-positive UDT. This research gives an understanding of recent trends and associations with concurrent opioid and benzodiazepine use by patients and may inform more targeted public health practice.