The association of tobacco use with prescription of muscle relaxants, benzodiazepines, and opioid analgesics for non-cancer pain.

BACKGROUND AND OBJECTIVES: Tobacco use and co-prescription of sedative hypnotics are risk factors for misuse of prescribed opioids among patients with non-cancer pain. However, the association between tobacco use and these co-prescriptions has not been clarified. We aimed to assess differences in the prescription and co-prescription rates of opioid analgesics with muscle relaxants and/or benzodiazepines between tobacco users and non-users.

METHODS: Visit data were obtained from the 2006 to 2009 National Ambulatory Medical Care Survey, an annual cross-sectional survey of visits to office-based physicians in outpatient settings in the United States. Our sample patients were aged ≥18 years and diagnosed with non-cancer back and neck pain. The χ2 test and multiple logistic regression analysis were used to assess bivariate and multivariate associations between prescription or co-prescription rates and tobacco use status.

RESULTS: We analyzed a total of 114,199,536 weighted visits (unweighted number: 3,521). Significant odds ratios (ORs) of tobacco users (vs non-users) for medical prescriptions were as follows: opioid analgesics, OR 2.14, 95% confidence interval (CI) 1.64-2.80; muscle relaxants and opioid analgesics, OR 2.57, 95%CI 1.76-3.74; benzodiazepines and opioid analgesics, OR 3.66, 95%CI 2.11-6.35, and muscle relaxants, benzodiazepines, and opioid analgesics, OR 7.02, 95%CI 2.98-16.57.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Tobacco users were more likely to receive prescriptions for opioid analgesics with muscle relaxants and/or benzodiazepines than non-users. Healthcare professionals need to limit co-prescription of opioid analgesics with muscle relaxants and/or benzodiazepines among tobacco users and provide a comprehensive approach to pain management. (Am J Addict 2019;XX:1-8).