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Concurrent opioid, benzodiazepine use increases mortality risk in PTSD

Study results indicated that patients with PTSD were at greater risk for death in the year following co-prescription of opioids and benzodiazepines than patients newly prescribed opioids only, benzodiazepines only or neither medication class.

Although clinical guidelines discourage opioid and benzodiazepine coprescribing, concurrent use is common among patients with PTSD, Eric J. Hawkins, PhD, of the Veteran Affairs Puget Sound Health Care System in Seattle, and colleagues wrote in Journal of Clinical Psychiatry.

Hawkins and colleagues estimated the all-cause mortality risk for patients in the VA health system with PTSD who were newly prescribed opioids and benzodiazepines at the same time compared with those who were prescribed benzodiazepines only, opioids only or neither medication in a propensity score–matched, retrospective, cohort study.

Researchers examined 1-year total and cause-specific mortality for 17,476 patients (adjusted for propensity score, age, baseline comorbidity and daily medication dose) using data from the VA Corporate Data Warehouse.

Each cohort included 4,369 patients. After 1 year, 116 deaths occurred among patients with PTSD taking both opioids and benzodiazepines, whereas 75 deaths occurred among benzodiazepine-only users (adjusted HR for all-cause mortality = 1.52; 95% CI, 1.14-2.03), 67 deaths occurred among opioid-only users (aHR = 1.76; 95% CI, 1.32-2.35) and 60 occurred among nonusers (aHR = 1.85; 95% CI, 1.3-2.64).

The most common causes of death were circulatory diseases (31%), respiratory diseases (12.3%) and overdose (10.7%), according to the study.

The investigators reported that adjusted subhazard ratio for concurrent opioid/benzodiazepine users was 1.81 (95% CI, 1.01-3.24) compared to nonusers for circulatory disease–related deaths. In addition, the risk for overdose death was higher among patients who concurrently used opioids and benzodiazepines compared with those in the benzodiazepine-only (adjusted subhazard ratio = 2.59; 95% CI, 1-6.66), opioid-only (adjusted subhazard ratio = 2.58; 95% CI, 1.09-6.11) and nonuser (adjusted subhazard ratio = 9.16; 95% CI, 2.27-37.02) cohorts.

“Current VA initiatives focus on decreasing opioid prescribing in primary care settings,” Hawkins and colleagues wrote. “Given that benzodiazepines are primarily prescribed in mental health clinics and prescribers are wary of addressing medications prescribed by others, it is critical to include mental health prescribers in efforts to discontinue dual use of these medications.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.