Mukaila Raji, MD and Yong-Fang Kuo, PhD received a second round of funding from the National Institute on Drug Abuse, NIH for grant, "Effectiveness, toxicity and safety of opioid and benzodiazepine substitutes," through 2024.

In 2016, the Centers for Disease Control and Prevention (CDC) issued guidelines for “all prescribers to avoid co-prescribing of benzodiazepine (benzo) and opioids”; other guidelines also advised against benzos for anxiety and insomnia because safer substitutes exist. Since the 2016 CDC guideline, use of gabapentinoids as an opioid substitute has risen. While recent data showed a decline in opioid prescribing rates after publication of the CDC guideline, a knowledge gap exists in terms of the rates, effectiveness and safety of opioid/benzo substitute prescribing and co-prescribing, especially in populations at high risk of drug toxicity: persons living with disabilities, the elderly and Medicare enrollees in home health care. Neither opioid nor benzo substitutes (gabapentinoids, Z-drugs, SNRIs and SSRIs) alone or in combination have been studied in these populations.

Dr. Raji & Dr. Kuo will use both 20% national Medicare data and a large commercial health insurance database to study the effectiveness and safety of the substitutes, whether the substitutes improve pain and function, and whether they have fewer toxicities. Our overall hypotheses is that the substitute drugs, alone or in combination, have considerably lower rates of serious toxicity than do opioids and benzos, with similar effectiveness in many clinical situations. If this is the case, its demonstration by our proposed research should result in acceleration in the shift away from opioids and benzos to safer alternatives.