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UPJ INSIGHT Procedural Benzodiazepine and Post-Vasectomy Opioid and Nonopioid Prescribing Variation in a Large Health Care System

By: Robert Webber, MD; Michael S. Patzkowski, MD, MHA; Ryan C. Costantino, PharmD, MS; Alexander G. Velosky, MHI; Vivian Lee, MD; Kyle L. Cyr, MD; Lisa M. Harris, DO; Maya Scott-Richardson, PhD; Krista B. Highland, PhD | Posted on: 01 Oct 2022

Webber R, Patzkowski MS, Costantino RC, et al. Procedural benzodiazepine and post-vasectomy opioid and nonopioid prescribing variation in a large health care system. Urol Pract. 2022;9(5)431-440.

Study Needs and Importance

The American Urological Association does not provide explicit recommendations for procedural benzodiazepine use or post-vasectomy pain management, but recommends prescribing opioids only when necessary, at the lowest effective dose. In this study, we described variation in procedural benzodiazepine and post-vasectomy nonopioid pain and opioid prescription dispense events of 40,584 patients within the U.S. Military Health System.

Figure. Variation by treatment facility in dispensed procedural benzodiazepine and post-vasectomy nonopioid and opioid prescriptions. Note facilities are ordered by vasectomy volume from low (1, top left) to high (35, bottom right).

What We Found

Whereas 32% of patients received a procedural benzodiazepine prescription (eg 1 pill), the majority were dispensed a nonopioid (71%) and/or an opioid (73%) prescription (see Figure). Most commonly, patients received both a nonopioid and opioid (34%) or all 3 medications (23%). A small proportion of patients dispensed a vasectomy-related opioid prescription later received an opioid refill within 30 days post-vasectomy (5%). Significant inequities in care pathways were identified for Black, Latino and Asian patients, and those whose race was Other relative to White patients. Patients were more likely to receive an opioid refill if they did not receive a nonopioid pain medication prescription.

Limitations

The use of electronic health record data may limit conclusions and scope of findings due to data missingness (eg race and ethnicity), lack of data on procedural techniques and lack of patient-reported outcomes. It is also unclear whether prescription dispense variation is due to variation in provider assessment, default order sets, prescribing patterns, patients’ choice to fill or not fill a prescription and the possibility that patients may have declined a nonopioid prescription offer due to having the medication at home. The Military Health System provides care to active duty service members, military retirees and their family members; generalizability is limited.

Interpretation for Clinical Care

Low rates of opioid refill and inequities in vasectomy-related pres­cribing practices highlight the need for system-level intervention to address excessive opioid prescribing and reduce unwarranted health care variation.

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