Women With Insomnia and OUD More Likely Than Men to Receive Benzodiazepines

Individuals with insomnia using buprenorphine for opioid use disorder (OUD), particularly women, were often prescribed sleep medications including benzodiazepines, according to results of a study published in Sleep.

In general, women are more likely to be prescribed benzodiazepines than men and patients with co-occurring OUD and insomnia can be high users of sedatives or hypnotics. It remains unclear, however, whether women with insomnia and OUD are prescribed sleep medications at a higher rate than men.

Investigators from the Virginia Commonwealth University School of Medicine in Richmond and Washington University School of Medicine in St. Louis, Missouri sourced data for this retrospective cohort study from Merative™ MarketScan^® Commercial and Multi-State Medicaid Databases. Patients (N=9510) who were diagnosed with insomnia and co-occurring OUD and received buprenorphine for a minimum of 6 months between 2006 and 2016 were evaluated for prescription fills for insomnia medications.

Patients had a mean age of 37.0 (SD, 11.7) years, 48.8% were women, 77.4% were White, 92.5% had an anxiety disorder, 66.9% had chronic pain, and 61.1% had a mood disorder. In addition, 10.5% also had alcohol use disorder, 8.0% had sedative use disorder, and 7.6% had stimulant use disorder.

Most of the patients received a prescription for nonbenzodiazepines or Z-drugs (zopiclone, eszopiclone, zaleplon, and zolpidem) (88.8%) and benzodiazepines (69.1%) and many for Z-drugs (40.9%). Stratified by gender, women were more likely to receive nonbenzodiazepines or Z-drugs (91.4% vs 86.2%), benzodiazepines (73.0% vs 65.3%), and Z-drugs (43.7% vs 38.2%) compared with men, respectively.

In the regression analyses, women were more likely to be prescribed Z-drugs (adjusted risk ratio [aRR], 1.26; 95% CI, 1.18-1.34), benzodiazepines (aRR, 1.17; 95% CI, 1.1-1.23), and nonbenzodiazepines or Z-drugs (aRR, 1.07; 95% CI, 1.02-1.12) than men. The trend for more women to receive sleep medication prescriptions than men remained when stratifying patients by race and ethnicity.

The major limitation of this study was that no data about the motivation for prescriptions were available and some of the sleep medications (eg, selective serotonin reuptake inhibitors) may have been for noninsomnia conditions.

This study identified that most individuals with OUD and comorbid insomnia received prescriptions for sleep medications. These data led the study authors to note, “The field of medication development targeting insomnia among individuals with OUD is underdeveloped, leaving researchers and clinicians without efficacy data for common insomnia treatments among the growing population of people receiving buprenorphine.”

This article originally appeared on Psychiatry Advisor