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Racial Disparities in Access After Regulatory Surveillance of Benzodiazepines
Sallie-Anne Pearson, PhD;
Stephen Soumerai, ScD;
Connie Mah, MS;
Fang Zhang, PhD;
Linda Simoni-Wastila, PhD;
Carl Salzman, MD;
Leon E. Cosler, PhD, RPh;
Thomas Fanning, PhD;
Peter Gallagher, PhD;
Dennis Ross-Degnan, ScD
Arch Intern Med. 2006;166:572-579.
Background We examined the effects of a prescription-monitoring program on benzodiazepine access among Medicaid enrollees living in neighborhoods of different racial composition.
Methods We used interrupted time series and logistic regression to analyze data from noninstitutionalized persons aged 18 years or older (N = 124 867) enrolled continuously in New York Medicaid 12 months before and 24 months and 7 years after initiation of the program. We used census data to identify the racial composition of the neighborhoods. Outcome measures were nonproblematic use (short term, within dosing guidelines), potentially problematic use (>120 days' use or more than twice the recommended dose), and pharmacy hopping (filling prescriptions for the same benzodiazepine in different pharmacies within 7 days).
Results There was a sudden, sustained reduction in benzodiazepine use in all the neighborhoods after the program's introduction. Despite the lowest rates of baseline use, enrollees in predominantly ( 75%) black neighborhoods experienced the highest rates of discontinuation after introduction of the program. This difference remained 7 years after policy initiation. Compared with white participants, black participants were more likely to discontinue nonproblematic (odds ratio, 1.78; 95% confidence interval, 1.47-2.17) and potentially problematic (odds ratio, 1.77; 95% confidence interval, 1.45-2.17) benzodiazepine use, after adjusting for sex, eligibility status, neighborhood poverty, and baseline use. The program almost completely eliminated pharmacy hopping in all racial groups, although less among white participants (82.6%) vs black participants (88.7%).
Conclusions A systematic benzodiazepine prescription-monitoring program reduced inappropriate prescribing, with a stronger effect in predominantly black neighborhoods despite lower baseline use. The policy may have resulted in an unintended decrease in nonproblematic use that disproportionately affects black populations.
Author Affiliations: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (Drs Pearson, Soumerai, Zhang, and Ross-Degnan and Mss Mah); School of Population Health and Community Medicine, University of New South Wales, Sydney, Australia (Dr Pearson); Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore (Dr Simoni-Wastila); Department of Psychiatry, Harvard Medical School and Massachusetts Mental Health Center, Boston (Dr Salzman); Department of Humanities and Social Sciences, Albany College of Pharmacy, Albany, NY (Dr Cosler); and Knowledge and Information Management Group, Office of Medicaid Management, New York State Department of Health, Albany (Drs Fanning and Gallagher).
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