usage of benzodiazepines or opiates among members who are in consistent methadone treatment in...
TRANSCRIPT
![Page 1: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/1.jpg)
Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia
Community Behavioral Health (CBH) Replication of Community Care Behavioral Health (CCBH) Study
Matthew O. Hurford, M.D.Chief Medical Officer, CBHAssistant Professor, Univ. of Penn.
![Page 2: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/2.jpg)
ObjectiveIdentify Community Behavioral
Health (CBH) Members in Philadelphia who are in methadone treatment and concurrently on benzodiazepines or opiates.
![Page 3: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/3.jpg)
Data sourcesAnaylsis period: July 1, 2010 –
September 30, 2010Paid methadone clinic claims
from all contracts for the analysis period.
Paid Medicaid pharmacy claims for the analysis period.
![Page 4: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/4.jpg)
Methodology Identify members in methadone treatment for at least
ten days in Q3 2010. Identify members in the above population who also filled
prescriptions for benzodiazepines or opiates during the same period.
Generate a distribution based on methadone providers in all the contracts.
Generate age group, gender, and racial distributions for the above population.
Identify the benzodiazepines and opiates used. Identify physicians and specialties to the extent possible.
Although this analysis was included in the original study by CCBH, CBH’s data warehouse contains very little information of this kind. Therefore, we were unable to produce a meaningful replication of this analysis.
![Page 5: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/5.jpg)
ResultsTable 1 shows the distribution of
members in methadone treatment and those with concurrent benzodiazepine or opiate prescriptions during the analysis period, by Philadelphia zip code.
![Page 6: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/6.jpg)
Table 1
![Page 7: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/7.jpg)
Table 1, continued
![Page 8: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/8.jpg)
ResultsTables 2, 3, and 4 show
demographics for members with concurrent methadone and benzodiazepine/opiate usage.
![Page 9: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/9.jpg)
Table 2: Age Distribution
Table 2:
![Page 10: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/10.jpg)
Table 3: Gender Distribution
![Page 11: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/11.jpg)
Table 4: Racial Distribution
![Page 12: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/12.jpg)
ResultsTable 5 shows the methadone
provider distribution.
![Page 13: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/13.jpg)
Table 5
![Page 14: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/14.jpg)
ResultsTable 6 shows the distribution of
members based on whether a benzodiazepine or opiate was prescribed. (Benzo = 1 if the member had a prescription for a benzodiazepine; otherwise Benzo = 0. Opiate = 1 if the member had a prescription for an opiate; otherwise Opiate = 0.)
![Page 15: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/15.jpg)
Table 6
![Page 16: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/16.jpg)
ResultsTables 7 and 8 show the details
of the benzodiazepines or opiates prescribed. Members had 2497 benzodiazepine prescriptions and 3067 opiate prescriptions.
![Page 17: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/17.jpg)
Table 7: Benzodiazepines
![Page 18: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/18.jpg)
Table 8: Opiates
![Page 19: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/19.jpg)
Comparison with CCBH DataCCBH shows that 45.8% of MAT
patients have concurrent prescriptions for benzodiazepines or opiates.
CBH shows that 45.6% of MAT patients have concurrent benzodiazepine or opiate prescriptions.
![Page 20: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/20.jpg)
Comparison with CCBH DataCCBH shows 44.9% of MAT patients with
concurrent prescriptions for benzodiazepines or opiates are ages 18-34; for CBH that number is 31.7%.
CCBH shows 31.3% of patients with concurrent scripts are ages 35-50 having concurrent scripts; for CBH that number is 42.2%.
CCBH shows 23.5% of MAT with concurrent scripts are 51-64; for CBH that number is 25.5%.
CCBH shows 0.3% of MAT patients having concurrent scripts are 65 or older; for CBH that number is 0.5%.
![Page 21: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/21.jpg)
Comparison with CCBH DataCCBH shows 57.6% of MAT
patients having concurrent scripts are female, whereas CBH shows 58.9% of patients who have concurrent scripts are female.
Percentages for male patients are 42.4% and 41.1%, respectively.
![Page 22: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/22.jpg)
Comparison with CCBH DataCCBH found that 7% of patients having
concurrent scripts were African-American. 87.3% were Caucasian, and 5.8% fell into other racial categories.
CBH found that 22.5% of patients with concurrent scripts were African-American or Black, 60.7% were Caucasian, and 16.8% fell into other racial categories.
Note that racial categories are constructed differently in the two BH/MCOs.
![Page 23: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/23.jpg)
Comparison with CCBH DataCCBH providers contributed 0.1%
to 33.1% to the sample.CBH providers contributed a
range of 2.87% to 22.5%.
![Page 24: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/24.jpg)
Comparison with CCBH Data
27.7% of CCBH’s patients with concurrent scripts had a prescription for an opiate.
50.2% had a prescription for a benzo.22% had a prescription for both. In CBH, 27.8% of patients with
concurrent scripts had a prescription for an opiate.
41.9% had a prescription for a benzo.30.3% had a prescription for both.
![Page 25: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/25.jpg)
Comparison to CCBH DataOf 3313 concurrent benzo scripts
in CCBH, clonazepam was prescribed the most often, at 17.3%
The same was true for CBH, where clonazepam made up 38.4% of concurrent benzo scripts.
![Page 26: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/26.jpg)
Comparison to CCBH DataCCBH CBH
Alprazolam 12.4% 33.7%Lorazepam 2.7% 7.4%Temazepam 2% 9.9%Diazepam 1.6% 7.2%Triazolam 0.2% 0.7%Flurazepam <0.1% 0.4%Chlordiazepoxide <.01% 0.3%Oxazepam <0.1% -----Estazolam ----- 0.3%Clorazepate ----- <0.1%
![Page 27: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/27.jpg)
Comparison to CCBH DataOf 1737 concurrent opiate scripts
in CCBH, 19% were for hydrocodone.
21.5% of CBH’s concurrent opiate scripts were for hydrocodone; CBH members were more likely to have scripts for oxycodone (30.2%).
![Page 28: Usage of Benzodiazepines or Opiates Among Members Who are in Consistent Methadone Treatment in Philadelphia Community Behavioral Health (CBH) Replication](https://reader033.vdocuments.us/reader033/viewer/2022052701/56649c6e5503460f94921395/html5/thumbnails/28.jpg)
Comparison to CCBH DataCCBH CBH
Oxycodone 17.6% 30.2%Tramadol 4.7% 13.8%Codeine 3% 14.4%Buprenorphine 2.4% 5.7%Methadone 1.3% 5.5%Propoxyphene 0.8% 4.1%Hydromorpohone 0.6% -----Fentanyl 0.5% 1.2%Morphine ----- 2.2%Diphenoxylate ----- 0.9%Meperidine ----- 0.2%Naltrexone ----- <0.1%Oxymorphone ----- <0.1%