Concurrent use of opioids and benzodiazepines quality measure.

Reducing risks through safer prescribing practices

The Concurrent Use of Opioids and Benzodiazepines (COB) quality measure promotes safe prescribing by identifying members concurrently prescribed an opioid with a benzodiazepine. These members are at a higher risk for serious adverse events including falls, sedation, respiratory depression, overdose, and death. Additionally, the American Geriatrics Society Beers Criteria® identifies benzodiazepines as potentially inappropriate for adults 65+ due to risks of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents.

How the measure calculates COB

The measure calculates the percentage of members 18+ with overlapping days’ supply of opioids and benzodiazepines for at least 30 cumulative days during the measurement period (excluding members with hospice, cancer, or sickle cell disease).

Strategies to reduce co-prescribing

• Offer alternative therapies for pain, anxiety, or insomnia.
• Limit dose and duration of opioid and benzodiazepine prescriptions.
• Prescribe short-term treatments (≤7 days supply, ≤2 weeks).
• Taper medications as appropriate to minimize withdrawal risks.
• Consider safer alternatives such as NSAIDs, SSRIs/SNRIs, CBT, or physical therapy.

Patient safety and shared decision-making

Providers should educate patients about the FDA black box warning for opioid/benzodiazepine combinations, review regimens regularly, and discuss safer alternatives. When discontinuing therapy, taper gradually to reduce risks. Consider prescribing naloxone as a rescue medication in case of unintentional respiratory depression.