(P-114) Comedication of Opioids with Benzodiazepines, Gabapentinoids Among Caregivers of Children with Special Healthcare Needs

Background: High caregiving burden among caregivers of children with special healthcare needs has been associated with chronic pain and mental conditions - which may inform opioid or central nervous system (CNS) agent prescriptions. However, the relationship between caregiving burden and risk-prone opioid comedication with gabapentinoids (GABA) or benzodiazepines (BZD) in this vulnerable population is unknown.

Objectives: To estimate the prevalence of guideline-recommended pharmacotherapeutic classes for chronic non cancer pain management and to examine the association between caregiving burden and co-prescription of opioids with benzodiazepines or gabapentinoids (O+B/G).

Methods: Cross-sectional analysis of pooled, nationally representative household surveys in the US from the 2010-2015 Medical Expenditure Panel Survey. Our sample included parents living with ≥1 child aged 17 and younger. High caregiving burden was defined as having at least a child with (a) need for prescription medications, (b) elevated health or educational service use, and (c) functional limitations. We estimated current survey round prevalence of (i) nonsteroidal anti-inflammatory (NSAID) (ii) opioid analgesic (iii) BZD (iv) GABA (v) adjuvant non-analgesic (ANAs) and (iv) neuromodulating analgesic (NMAs) use. O+B/G was defined as concurrent receipt of opioids and either BZD or GABA in the current survey round. Multivariate logistic regression examined the association between caregiver burden and O+B/G, adjusted for caregiver socio-demographics, chronic pain, mental disorder, disability, ≥2 comorbid chronic conditions, and delayed/unmet needed healthcare status. All estimates and 95% confidence intervals (CI) were weighted to represent the national census-based population.

Results: Prevalence of medication use among high and low caregiving burden was 13% vs 7% (opioids), 6% vs 2% (BZD), 3% vs 1% (GABA), respectively. High caregiving burden was not associated with increased odds of co-prescribed O+B/G (OR 1.29 CI 0.86 -1.92). Caregivers with mental disorders (OR 4.08 CI 2.98 -5.60); chronic pain (OR 2.10 CI 1.49 - 2.98) and disability (OR 1.99 CI 1.29 – 3.07) were at least twice as likely to be prescribed O+B/G.

Conclusions: Caregivers with high burden of care and chronic pain, and their children, may constitute populations at high-risk in the setting of co-prescription with BZDs or GABAs. Exploring underlying causal mechanisms is warranted to understand impact of risky CNS agent co-prescribing with opioids in caregivers.