Overlapping prescriptions of opioids, benzodiazepines, and carisoprodol: “Holy Trinity” prescribing in the state of Florida

Yanning Wang, Chris Delcher, Yan Li, Bruce A. Goldberger, Gary M. Reisfield

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: High-risk combinations of controlled medications, such as those involving opioid analgesics, are under increased scrutiny because of their contribution to the opioid epidemic in the United States. Responsible prescribing guidelines indicate that the triple drug combination–opioids, benzodiazepines and skeletal muscle relaxants, especially carisoprodol–should not be concurrently prescribed. Methods: This pharmacoepidemiologic study was designed to primarily examine the characteristics of patients receiving this triple combination compared to the group receiving only opioids and benzodiazepines. Results: Results show that, while the number of exposed patients has declined since 2012, approximately 17,000 Floridians were prescribed this combination in 2017 alone. Demographically, recipients of these prescriptions were younger, more likely to be female, and geographically-localized. Furthermore, these patients were more frequently associated with a prescriber in the top 1% of opioid and/or benzodiazepine prescribing, have more multiple provider episodes (“doctor shopping”), and receive higher mean daily opioid dosages. Conclusions: These findings raise important questions as to how frequently prescribers are checking prescription drug monitoring programs, following US Centers for Disease Control and Prevention opioid prescribing guidelines, and/or handling the clinical challenges associated with pharmaceutical management of patients with complex, painful health conditions.

Original languageEnglish
Article number107693
JournalDrug and Alcohol Dependence
StatePublished - Dec 1 2019

Bibliographical note

Funding Information:
This work was supported by Grant No. 2016-PM-BX-K005 and 2017-PM-BX-K038 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Department of Justice's Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice.

Publisher Copyright:
© 2019 Elsevier B.V.


  • Benzodiazepine
  • Carisoprodol
  • Inappropriate prescribing
  • Opioid
  • Prescription drug monitoring program

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)


Dive into the research topics of 'Overlapping prescriptions of opioids, benzodiazepines, and carisoprodol: “Holy Trinity” prescribing in the state of Florida'. Together they form a unique fingerprint.

Cite this