This article is more than 5 years old. Information may no longer be current.

Benzodiazepine users five times more likely to overdose on opioids

The use of benzodiazepines was linked to a fivefold increase in the risk for opioid-related overdose during the first 90 days of such treatment, according to findings recently published in JAMA Network Open.

“The concurrent administration of benzodiazepines increases the risk of opioid-related overdose because of the combination of their depressant effects on the central nervous system’s controls for respiration. For this reason, the [CDC] recommends against their concurrent use,” Immaculata Hernandez, PharmD, PhD, of the School of Pharmacy at the University of Pittsburgh, and colleagues wrote.

“Despite this recommendation, the concurrent use of opioids and benzodiazepines has increased by more than 40% in the last 12 years, and in 2013 more than 20% of patients taking opioids used benzodiazepines concurrently,” they added.

For their retrospective review, they split 71,248 patients (mean age, 66.5 years) into two groups based on whether they had opioid and/or benzodiazepine supplies the day prior to overdose or censoring. The group that had both (n = 20,665) was further broken up into four subgroups based on the number of days, from 1 to more than 271, with overlapping supplies.

Hernandez and colleagues found that 68.4% of the 20,665 simultaneous users had more than 180 days of overlapping supplies of both medications. The risk for overdose was highest on the first days of concurrent benzodiazepine use and opioid and decreased over time. The HRs for overdose were 5.05 (95% CI, 3.68-6.93) during the first 90 days of simultaneous benzodiazepine and opioid use and 1.87 (95% CI, 1.25-2.8) for days 91 to 180 among those who did not have an overdose before 90 days compared to those who received only opioids.

“These results demonstrate the important role that fragmentation of care plays in the inappropriate use of opioids and in the subsequent risk of overdose, and warrant the extended use of prescription monitoring programs and the implementation of new policy interventions that further control the receipt of opioid prescriptions by multiple prescribers,” Hernandez and colleagues wrote.

“For example, states could require clinicians to check the prescription drug monitoring programs before prescribing benzodiazepines for patients with a history of opioid use, as it is currently done in some states for certain controlled substances.”

Researchers added that based on the findings, clinicians should avoid prescribing benzodiazepines to their patients who are currently using opioids. – by Janel Miller

Disclosures: None of the authors report any relevant financial disclosures.