(SLB-039) Adverse Events Associated with Concomitant Use of Opioids and Psychotropic Medications

Monday, August 25, 2025

11:45 AM - 12:45 PM ET

Presenting Author(s)

OG

Omkar Ghodke

Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA, United States

Co-Author(s)

AA

Arman Arabshomali

Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA, United States
SM

Shishir Maharjan

Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA, United States
EP

Eric Pittman

Department of Pharmacy Administration and Center for Pharmaceutical Marketing & Management, School of Pharmacy, University of Mississippi, University, MS, USA, United States
DS

Dennis Smith

Mississippi Division of Medicaid, Jackson, MS, USA, United States
TK

Terri Kirby

Mississippi Division of Medicaid, Jackson, MS, USA, United States
KB

Kaustuv Bhattacharya

Department of Pharmacy Administration and Center for Pharmaceutical Marketing & Management, School of Pharmacy, University of Mississippi, University, MS, USA, United States

Background: Concomitant use of opioids and psychotropic medications is frequently observed in pain management, but increases the risk of adverse outcomes, including respiratory depression, opioid overdose, and falls. This study aims to assess the relationship between concomitant opioid-psychotropic use and the occurrence of adverse events in Medicaid members receiving long-term opioid therapy (LTOT).

Objectives: To evaluate the impact of concomitant opioid-psychotropic medication use on adverse events, including opioid overdose, respiratory complications, and fall-related injuries, among Mississippi Medicaid members receiving LTOT.

Methods: A nested case-control study was conducted using Mississippi Medicaid administrative claims data (April 2018–June 2023). The study population included Medicaid members ≥18 years old who initiated LTOT between January 1, 2019, and June 30, 2023. LTOT was defined as ≥3 opioid prescriptions with a cumulative 45-day supply in a 90-day period, preceded by 90 days without opioid use. Cases were defined as individuals experiencing (1) opioid overdose or mortality, (2) respiratory complications, or (3) falls/fractures. Controls were matched 1:2 using incidence density sampling based on time of cohort entry. The primary exposure was ≥7 days of concomitant opioid-psychotropic medication use in the 90 days preceding the event. Sensitivity analyses were conducted using 15-day and 30-day exposure definitions. Conditional logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI), adjusting for demographics, chronic pain conditions, substance use disorder, and comorbidities.

Results: The final cohort included 9,702 Medicaid members receiving LTOT. Among cases, 156 opioid overdose/mortality cases, 247 respiratory complications, and 608 fall/fracture cases were identified and matched to controls. Individuals with ≥7 days of concomitant use had significantly increased odds of experiencing respiratory complications (aOR = 2.80, 95% CI: 1.91–4.18). Sensitivity analyses showed a dose-response relationship for opioid overdose/mortality, with aORs of 1.64 (7 days, CI: 0.98-2.76), 1.92 (15 days, 95% CI: 1.17–3.20), and 2.42 (30 days, 95% CI: 1.49–3.98). No significant association was observed for falls/fractures.

Conclusions: Concomitant opioid-psychotropic medication use among Medicaid members on LTOT is associated with significantly higher risks of respiratory complications and opioid-related mortality, particularly with prolonged exposure. These findings underscore the need for enhanced prescribing guidelines, clinician education, and risk mitigation strategies to improve patient safety.