# Developing a Real-Time Trajectory Tool to Identify Potentially Unsafe Concurrent Opioid and Benzodiazepine Use among Older Adults

> **NIH NIH R21** · UNIVERSITY OF FLORIDA · 2020 · $193,936

## Abstract

Project Summary/Abstract
Prescription opioid overdose deaths have increased markedly in the past two decades, with a third of these
fatalities involving concurrent benzodiazepine (BZD) use. Despite clinical guidelines and FDA black-box
warnings cautioning against concurrent opioid (OPI) and BZD use (hereafter OPI-BZD use), the number of
patients using OPI-BZD increased by 41% between 2002 and 2014. OPI-BZD use increases the risk of
overdose and other adverse outcomes (e.g., falls, fractures, cognitive dysfunction), especially among older
adults.
The dose and duration of OPI-BZD use varies by patient characteristics and comorbid conditions. However,
little is known about the thresholds of duration and dose or patterns of OPI-BZD use profiles most associated
with the risk of overdose and other adverse outcomes among older adults. Prior studies have defined OPI-BZD
use with arbitrary thresholds (e.g., ≥1 day overlapped supply) and focused only on duration or dose alone
rather than combinations of duration and dose of concurrent use. Applying arbitrary and broad thresholds
without evidence and validation to all patients imposes challenges in tailoring clinical care, and leads to
ineffective therapies and interventions involving OPI-BZD use. Alternatively, advanced group-based trajectory
models (GBTMs) can be used to better characterize OPI-BZD use in clinical practice. GBTMs have the ability
to account for dynamic medication use, identify subgroups with similar changes over time, and simultaneously
examine dose and duration thresholds or other patterns most relevant to outcomes in order to better aid clinical
decision-making.
The proposed study aims at developing an innovative, real-time “Predicting Risky Opioid-Benzodiazepine
Trajectory e-Care Tool (PROTeCT)” for efficiently identifying and predicting subgroups of older adults (aged
≥50 years) with distinct and potentially unsafe patterns of OPI-BZD use. Because both Medicare and Medicaid
enrollees are experiencing an increased number of chronic pain conditions, mental health/substance use
disorders, and prescription OPI use, Medicare and Medicaid are ideal settings for developing the PROTeCT
tool. Using national Medicare claims and Arizona (AZ) and Florida (FL) Medicaid data from 2013-2016, Aim 1
focuses on identifying distinct trajectories of OPI-BZD use. We will also identify predictors associated with
specific trajectories or patterns. In Aim 2, we will identify the distinct trajectories or patterns of OPI-BZD use
that are the most closely associated with two separate outcomes (i.e., overdoses; falls and fractures). Finally,
we propose to develop a beta-version of a real-time PROTeCT platform capable of prospectively and iteratively
predicting patients with unsafe patterns of OPI-BZD use by prospectively analyzing more recent data from the
2017-2019 Medicaid in AZ and FL. The infrastructure of our findings and tool may be generalizable to
Medicare, Medicaid programs in other states or other heal...

## Key facts

- **NIH application ID:** 9923531
- **Project number:** 5R21AG060308-02
- **Recipient organization:** UNIVERSITY OF FLORIDA
- **Principal Investigator:** Wei-Hsuan Jenny Lo-Ciganic
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $193,936
- **Award type:** 5
- **Project period:** 2019-05-01 → 2022-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9923531

## Citation

> US National Institutes of Health, RePORTER application 9923531, Developing a Real-Time Trajectory Tool to Identify Potentially Unsafe Concurrent Opioid and Benzodiazepine Use among Older Adults (5R21AG060308-02). Retrieved via AI Analytics 2026-05-29 from https://api.ai-analytics.org/grant/nih/9923531. Licensed CC0.

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