Opioid and Benzodiazepine Use Among a Population-Based Cohort of Adults With Chronic Spinal Cord Injury: Correspondence Between Self-report and State Prescription Monitoring Data.

Abstract

To compare self-reported opioid and benzodiazepine use to rates of prescriptions dispensed among persons with chronic spinal cord injury (SCI), to evaluate the extent of potential underreporting. Cross-sectional self-report assessment (SRA) and retrospective review of prescription monitoring program (PMP) data. Community dwelling adults in the Southeastern United States. In total, 345 adults (N=345) (>18y) with chronic (>1y) SCI who were identified through a state population-based SCI registry and who responded to SRA opioid use questions in a parent study. Not applicable. Self-reported prescription pain reliever, sedative, and tranquilizer use, and prescriptions dispensed based on PMP data. We compared self-reported past year utilization with records of dispensed prescriptions to assess potential underreporting, defined as reporting "never" using either opioids (pain relievers) or benzodiazepines (sedatives/tranquilizers) in the past year, but having had 2 or more respective prescriptions dispensed in the year before the SRA. Among the 345 participants who responded to the opioid use questions, we were able to match 252 to the PMP; reasons for not matching include not filling a controlled substance prescription in-state, either because of lack of reportable prescriptions or the prescription was dispensed out of state. Evaluating each prescription medication, rates of underreporting for each drug ranged from 0.4% to 4% for hydrocodone, oxycodone, tramadol, codeine, buprenorphine, and hydromorphone. There was 100% agreement in the self-reported use and dispensed records for fentanyl, oxymorphone, meperidine, and methadone. The rates of potential underreporting of benzodiazepines were <2%. Overall, of the 252 matched individuals, 11% underreported opioids (2 or more prescriptions dispensed) and 1% underreported benzodiazepines. The findings suggest considerable agreement between self-reported and dispensed prescription medication use, and only minimal potential underreporting of select opioids and benzodiazepines, confirming the appropriateness of self-report of these prescription medications with people with SCI.