Using Big Data to Elucidate Perioperative Benzodiazepine Receptor Agonist and Opioid Prescribing in Older Adults

Kevin Xu, MD, MPH, Instructor, Psychiatry

Older adults in the U.S. are experiencing an endemic of drug-related poisonings, which is exacerbated by a high prevalence of prescriptions for benzodiazepine receptor agonists (BZDRAs) and/or opioids in the elderly. Because BZDRAs and opioids are commonly used to manage acute postoperative symptoms such as pain, insomnia, and anxiety in the immediate postoperative period, clinicians are challenged by the balance of limiting BZDRA and opioid prescriptions while providing effective postoperative symptom relief. There is increasing evidence showing that many adults who receive BZDRAs and opioids after surgery go on to become persistent users. Unfortunately, postoperative trajectories of BZDRA and opioid use in specifically older adults have not been studied, an important research gap given the high rates of morbidity and mortality in older adults receiving surgery in the U.S.

Our analysis is focused on the relationship between rurality and progression of short-term postoperative BZDRA and opioid use to long-term dependence. De-prescribing of opioids and BZDRAs after surgery requires intensive systems-based interventions that may be difficult to implement in rural areas due to provider shortages. The value of using geospatial data to curb the crisis of drug-related poisonings in the elderly is supported by previous research, which has identified rural residence as one of the strongest predictors of high-risk psychotropic polypharmacy in U.S. adults. Against this backdrop, our proposal will use national administrative data from the PearlDiver Patient Records Database (containing claims of >20 million patients enrolled in all private and public insurance) and subsequently seek to replicate these findings using regional hospital records from the BJC HealthCare system. This will allow us to evaluate place-based inequities in the utilization of BZDRAs and opioids in older adults following surgery. Our work will provide preliminary data for a future NIDA R01 headed by our investigators to evaluate trajectories of BZDRA and opioid prescribing–and their downstream overdose risk–in older adults via national administrative data (CMS Medicare claims).