Trends in Co-Prescribing Opioids and Gabapentinoids Among Medicare Beneficiaries, 2017 to 2022

Background: Co-prescribing opioids and gabapentinoids (GABA, gabapentin and pregabalin) is associated with increased risk of falls, fractures, opioid overdose and deaths. The Centers for Disease Control and Prevention (CDC) in 2016 and the Food and Drug Administration (FDA) in 2019 recommended caution in such co-prescribing. A key step in updating policy and revising prescribing guidelines aimed at reducing opioid and GABA co-use and its associated consequences is a thorough understanding of the prescriber and the patient factors associated with co-use. We thus examined national trends and patterns in opioid and GABA co-prescribing among Medicare beneficiaries from 2017 to 2022. Methods: We conducted a retrospective study of Medicare beneficiaries with ≥90 consecutive days of opioid use from 2017 to 2022. The study outcome was GABA use during the 90-day opioid use episode. A multivariable logistic regression model was constructed to examine the patient, prescriber and prescription factors associated with receiving a GABA prescription. Results: Our sample comprised 8035 opioid-only and 2818 opioid and GABA users. Non-cancer (e.g., back and neuropathic) pain was a more common diagnosis in the opioid and GABA cohorts than in the opioid-only cohorts. The opioid-GABA co-prescribing rate did not substantially change (2017: 24.5%, 2019: 28.2% and 2022: 25%). Co-prescribing rates were higher in non-white patients, those on Medicaid and Medicare, and those whose initial Medicare entitlement was not based on age. Tramadol and hydrocodone were the most prescribed opioids. Approximately 33% of opioid and GABA users started with an initial daily GABA dose of ≥1200 mg. In the 12-month lookback period, patients on opioids and GABA had nearly 17 clinic visits to approximately 8 different providers. Factors associated with co-prescribing were seeing pain physicians (odds ratio = 1.29, 95% confidence interval-[CI] = 1.11–1.50), having more healthcare encounters (6–11 visits, odds ratio-[OR] = 1.19, 95% CI = 1.02–1.39; 12–19, OR = 1.20, 95% CI = 1.00–1.43; 20+, OR = 1.27, 95% CI = 1.03–1.57) and seeing >10 providers (OR = 1.40, 95% CI = 1.12–1.73). Conclusions: One in four Medicare beneficiaries with long-term opioid use received opioid and GABA prescriptions. Our findings of association in co-prescribing with multiple visits to different clinics/prescribers can inform the development of public health policy and practice guidelines (e.g., prescription-drug monitoring program checks within electronic medical records, EMR alerts with opioid and GABA co-prescribing) to potentially reduce opioid and GABA prescriptions and associated adverse outcomes.