Developing Quality Metrics Regarding the Concomitant Use of Opioids and Benzodiazepines and Benzodiazepine-Like Hypnotics

Abstract

Background: In response to the opioid epidemic and its effects, the Centers for Medicare & Medicaid Services (CMS) have aimed to gather information to compose an evidence-based guideline that protects the wellbeing of Medicare and Medicaid beneficiaries. Objectives: The purpose of this project was to evaluate benzodiazepines and benzodiazepine-like hypnotics when used in combination with opioids to determine if there is sufficient evidence of opioid potentiation to support the development of quality metrics regarding their concomitant use. Methods: This was a retrospective literature review project of eight articles related to benzodiazepines and three articles related to benzodiazepine-like hypnotics potentiating the effects of opioids. The following limiters were applied to all searches: peer reviewed, full text, libraries worldwide, and published between 2008-2018. Results: Based upon the eight articles related to benzodiazepines, a quality metric of no concomitant use is recommended. Based upon the three articles related to benzodiazepine-like hypnotics, a quality metric of avoiding the combination or implementing a time-dependent limiter between the last opioid dose and the hypnotic dose is recommended. Conclusions: A standardized quality metric regarding the concomitant use of benzodiazepines and benzodiazepine-like hypnotics could be utilized to monitor and unify the current standards of care and allow a more streamlined approach to the use of opioids in practice.