Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Risks with Opioid and Benzodiazepine Concurrent Use
BMJ; ePub 2017 Mar 14; Sun, Dixit, et al
Concurrent prescription benzodiazepine/opioid use increased in the US between 2001 and 2013, contributing significantly to the overall population risk of opioid overdose, a recent study found. The study included 315,428 privately insured individuals aged 18 to 64 years who filled at least 1 prescription for an opioid during the study period. Researchers found:
- Concurrent benzodiazepine/opioid prescribing increased by nearly 80% during the study period (from 9% of opioid users in 2001 to 17% in 2013).
- Opioid users who also used benzodiazepines were at substantially higher risk of an emergency room visit or inpatient admission for opioid overdose.
- This risk could be reduced by 15% with the elimination of concurrent use of benzodiazepines and opioids.
Sun EC, Dixit A, Humphreys K, Darnall BD, Baker LC, Mackey S. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. [Published online ahead of print March 14, 2017]. BMJ. doi:10.1136/bmj.j760.
This Week's Must Reads
Must Reads in Addiction Medicine
Acute Illness and Cannabis Use in Adults, Ann Intern Med; ePub 2019 Mar 26; Monte, et al
Dual Receipt of Rx Opioids & Overdose Death, Ann Intern Med; ePub 2019 Mar 12; Moyo, et al
Opioid-Related Mortality in US by Opioid Type, JAMA Netw Open; 2019 Feb 22; Kiang, et al
Disparities in the Prescription of Opioids, JAMA Intern Med; ePub 2019 Feb 11; Friedman, et al
Prevention of Prescription Opioid Misuse in the US, JAMA Netw Open; 2019 Feb 1; Chen, et al
Almost 30% of fatal opioid overdoses occur in patients who are also being prescribed benzodiazepines.1 Benzodiazepines can increase the respiratory depressive effects of opioids, and if a greater does than prescribed is taken, or another respiratory depressant such as alcohol is added to the mix, the risk of an adverse occurrence may be particularly high. Due to this concern, the FDA recently updated a boxed warning about the combination of benzodiazepines and opioids. The current study is very concerning in that there has been a large increase in co-prescribing of both drugs over the last 10 years. While some individuals may need both medications, as chronic and acute pain increases the likelihood of a patient having severe anxiety or sleep disturbance, the large increase in use over the last decade suggests a lack a caution before prescribing both medications. When we catch ourselves prescribing both an opioid and a benzo, we should pause, think carefully about whether the combination is really needed, then proceed accordingly. —Neil Skolnik, MD