June 17, 2015
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Concurrent benzodiazepine, opioid prescription increases risk for overdose death among veterans

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Prescription of benzodiazepines increased risk for death from a drug overdose among veterans receiving opioid analgesics, according to study findings in BMJ.

“Trends in overdose deaths have been connected to patterns of opioid prescribing, an increasingly common treatment for pain. On a population level, increasing rates of opioid prescribing have been linked to an increased rate of overdose death; on an individual level, the risk of overdose death is higher among those receiving higher doses of opioids,” Tae Woo Park, MD, of the Warren Alpert Medical School at Brown University, and colleagues wrote.

Tae Woo Park, MD

Tae Woo Park

To investigate associations between the risk for overdose and benzodiazepine prescribing patterns among US veterans receiving opioid analgesics, researchers assessed electronic medical records from the Veterans Health Administration from 2004 to 2009. The final study cohort included 422,786 veterans, of which 2,400 died of a drug overdose while receiving opioid analgesics.

Twenty-seven percent of patients prescribed opioid analgesics were also prescribed benzodiazepines during the study period.

Approximately half of drug overdoses occurred while patients were prescribed both benzodiazepines and opioids (n = 1,185).

Unadjusted analysis showed drug overdose rates were higher when patients were currently prescribed benzodiazepines compared with when patients were formerly prescribed or not at all prescribed benzodiazepines.

Current benzodiazepine prescription (HR = 3.86; 95% CI, 3.49-4.26) and former benzodiazepine prescription (HR = 2.33; 95% CI, 2.05-2.64) were associated with increased risk for drug overdose death.

Higher benzodiazepine dosage was associated with greater risk for overdose death. However, temazapam was associated with a decreased risk for drug overdose death (HR = 0.63; 95% CI, 0.48-0.82) compared with clonazepam.

“Although the design of this study does not allow for the determination of the extent to which benzodiazepines cause overdose deaths, it does indicate a need for clinicians to be aware of the increased risk of overdose death among patients currently receiving benzodiazepines and opioids and that the risk may be higher among those receiving higher doses of either or both medications,” the researchers wrote. “This risk may be due to risks inherent to those prescribed benzodiazepines, such as the presence of an anxiety condition, and/or to the benzodiazepine itself. Thus, clinicians might take caution when prescribing benzodiazepines to this group.”

“Clinicians should be cautious in prescribing these drugs in combination, particularly at higher doses of either drug, with careful weighing of risks and benefits, and might consider providing naloxone for patients who receive this drug combination, particularly those receiving higher doses of these drugs,” Park told Healio.com/Psychiatry. – by Amanda Oldt

Disclosure: The study was funded by the Veteran Affairs Health Services Research and Development Service Center and the NIH. Please see the study for a list of all other authors’ financial disclosures.