Concurrent Use of Opioids and Benzodiazepines (COB)*

The clinical impact of this performance measure is high, as opioid abuse can lead to unintended consequences. As an inverse performance measure, performance rates with lower scores indicate higher quality care. Performance rates were 22 percent for Medicare plans, demonstrating a performance gap. The 2022 CDC recommendation changed from “avoid prescribing opioids and benzodiazepines concurrently” to “use particular caution when prescribing opioids and benzodiazepines concurrently”. The 2022 CDC recommendation update considers patient preferences and values. Additionally, while the CDC guideline states that taking opioids and benzodiazepines at the same time is higher risk, there is no data justifying what dosage constitutes a higher risk. The committee had difficulty following the performance measure logic and was concerned with the clarity of the specifications. Unclear instructions to calculate the performance measure could lead to incorrect performance rates. The developer should also revise the “concurrent use” definition to signify medications taken simultaneously, not just prescribed in the same year. Concurrent prescribing is not the same as concurrent use. This performance measure has been tested and validated at the health plan level and is currently implemented only at that level. However, the committee noted that these performance measures can affect individual physicians if they participate in an integrated delivery system. Some delivery systems lack standardized data management systems, which can make it challenging to obtain the patient’s medication history. Physicians in areas with higher cross coverage, i.e., physicians that provide care for other physicians when they are not available, may be penalized.