Concurrent Use of Opioids and Benzodiazepines
Date: 06/10/25
Concurrent Use of Opioids and Benzodiazepines
Simultaneous use of multiple medications can significantly increase patients’ risk for adverse outcomes. The Centers for Medicare & Medicaid Services will help reduce theserisks, by implementing the Concurrent Use of Opioids and Benzodiazepines (COB) measure. This measure aims to help identify patients at high risk for serious adverse effects when using these two classes of medications together.
| Quality Measure | Description |
|---|---|
| Concurrent Use of Opioids andBenzodiazepines (COB) | Percentage of patients ages 18 years or older with 30 cumulativedays of overlap with opioids and benzodiazepines |
| COB Exclusions | Patients diagnosed with cancer, sickle cell disease, or enrolledin hospice palliative care. |
| What qualifies a member for theCOB measure? | Two fills of any opioids with at least 15 cumulative days’ supplyduring the year. |
| What makes a member non-compliantwith the COB measure? | At least two fills of any benzodiazepine(s) with 30 days of overlapwith opioids during the year. |
Drug Examples
Listed below are examples of opioids and benzodiazepines. Please consider evaluating your patients’medication list before prescribing new drugs, as well as opportunities to de-prescribe.
Note: This is not an all-inclusive list.
| Opioids | Benzodiazepines |
| Codeine | Alprazolam |
| Fentanyl | Clonazepam |
| Hydrocodone | Diazepam |
| Morphine | Lorazepam |
| Oxycodone | Midazolam |
| Tramadol | Oxazepam |
| Temazepam |