Despite risks, opioid users more likely to receive sedating medications

Individuals who used or abused opioids were significantly more likely to receive sedating medications, including benzodiazepines, than those who did not use opioids, data show.

Opioid use can lead to sleep disruptions, Andrew S. Tubbs, BSc, an MD/PhD candidate at the University of Arizona College of Medicine, told Healio Primary Care. Sedating medications for poor sleep, when combined with opioids, may suppress respiratory drive, he said.

“The literature on sleep and opioids is still relatively small for how extensive a problem opioid use is,” Tubbs said. “Furthermore, the data on the use of sedating medications among users of opioids is even smaller.”

To help fill in this data gap, Tubbs and colleagues analyzed 171,766 responses to the National Survey on Drug Use and Health from 2015 to 2018 to determine how often opioids are used in conjunction with sedating medications. They described opioid users as “someone who used a prescription opioid as prescribed within the past 12 months and [opioid abusers] as someone who used a prescription opioid inappropriately (eg, was not theirs or took more than prescribed) or used an illegal opioid (eg, fentanyl) also within the past 12 months.”

Their results, presented virtually at SLEEP, indicated that opioid use and abuse varied by age, sex, race, education and income (P for trend < .001). When adjusted for age, sex and race, the use of benzodiazepines like temazepam, flurazepam and triazolam was more common among those who used opioids (OR = 4.4; 95% CI, 4.04-4.79) and those who abused opioids (OR = 11.9; 95% CI, 9.72-14.5). The use of z-class drugs like zaleplon, zolpidem and eszopiclone was also more prevalent in those who used opioids (OR = 3.69; 95% CI, 3.48-3.89) and those who abused opioids (OR = 7.74; 95% CI, 6.97-8.6). Additional data adjustments for income, education and mental illness reduced the magnitude of the links, according to the researchers.

“We were surprised by the extent of the combined use of both classes of drugs,” Tubbs said. “At least 9% of the individuals using an opioid had also used a sedating medication despite the increased risk for overdose death with combined use.”

He added that “millions of Americans face an increased risk for an overdose just because they cannot sleep.”

“Fortunately, there is a lot that primary care physicians can do to address this issue,” Tubbs said.

For example, PCPs can avoid prescribing high-risk sedating medications to patients who use opioids and refer patients with insomnia and other sleep issues to a behavioral sleep medicine specialist for treatment, according to Tubbs.