In the Journals

Concurrent benzodiazepine, opioid use increases from 2001 to 2013

Concurrent use of benzodiazepines and opioids significantly increased from 2001 to 2013 and largely contributed to increases in overall population risk for opioid overdose, according to recent findings.

“Nearly 30% of fatal ‘opioid’ overdoses also involve benzodiazepines, which are often used concurrently with opioids, raising the possibility that some of the increase in opioid-related deaths could be caused by increases in concurrent benzodiazepine/opioid use over time,” Eric C. Sun, PhD, of Stanford University School of Medicine, and colleagues wrote. “Although benzodiazepines have received less public safety attention than opioids, the combination of the two drugs is dangerous because benzodiazepines potentiate the respiratory depressant effects of opioids.”

Eric Sun, PhD
Eric C. Sun

To assess trends in concurrent use of benzodiazepines and opioids in comparison with trends in hospital admissions and ED visits for opioid overdose, researchers analyzed claims data from 2001 to 2013 for 315,428 privately insured individuals aged 18 to 64 years who were continuously enrolled in a health plan with medical and pharmacy benefits and filled a prescription for an opioid.

In 2001, 9% of opioid users also used a benzodiazepine, compared with 17% in 2013. This 80% increase in concurrent use was significantly due to increases among intermittent opioid users, according to researchers.

Concurrent use of opioids and benzodiazepines was associated with an increased risk for ED visits or inpatient admission for opioid overdose among all opioid users (adjusted OR = 2.14; 95% CI, 2.05-2.24; P < .001), compared with opioid users who did not use benzodiazepines.

Intermittent opioid users had an adjusted odds ratio for an ED visit or inpatient admission for opioid overdose of 1.42 (95% CI, 1.33-1.51; P < .001) vs. 1.81 (95% CI, 1.67-1.96; P < .001) among chronic opioid users.

If the association is causal, eliminating concurrent use of opioids and benzodiazepines could reduce risk for ED visits and inpatient admissions for overdose by approximately 15%, according to researchers.

“Sun and colleagues found an alarming rise in this prescribing practice in their study population, from 9% in 2001 to 17% in 2013. They report a significantly increased risk of overdose among patients receiving both drug types concurrently, documenting one type of harm associated with this unsound and growing clinical practice,” Pinar Karaca-Mandic, PhD, of University of Minnesota School of Public Health, and colleagues wrote in an accompanying editorial. “A multi-pronged effort from both regulators and experts writing clinical guidelines, along with extensive expansion in warnings about the hazards of drug-drug interactions, are essential to reduce low value, potentially dangerous care.” – by Amanda Oldt

Disclosure: Sun and colleagues report receiving support from grants from the Foundation for Anesthesia Education and Research. Please see the study for a full list of relevant financial disclosures.

Concurrent use of benzodiazepines and opioids significantly increased from 2001 to 2013 and largely contributed to increases in overall population risk for opioid overdose, according to recent findings.

“Nearly 30% of fatal ‘opioid’ overdoses also involve benzodiazepines, which are often used concurrently with opioids, raising the possibility that some of the increase in opioid-related deaths could be caused by increases in concurrent benzodiazepine/opioid use over time,” Eric C. Sun, PhD, of Stanford University School of Medicine, and colleagues wrote. “Although benzodiazepines have received less public safety attention than opioids, the combination of the two drugs is dangerous because benzodiazepines potentiate the respiratory depressant effects of opioids.”

Eric Sun, PhD
Eric C. Sun

To assess trends in concurrent use of benzodiazepines and opioids in comparison with trends in hospital admissions and ED visits for opioid overdose, researchers analyzed claims data from 2001 to 2013 for 315,428 privately insured individuals aged 18 to 64 years who were continuously enrolled in a health plan with medical and pharmacy benefits and filled a prescription for an opioid.

In 2001, 9% of opioid users also used a benzodiazepine, compared with 17% in 2013. This 80% increase in concurrent use was significantly due to increases among intermittent opioid users, according to researchers.

Concurrent use of opioids and benzodiazepines was associated with an increased risk for ED visits or inpatient admission for opioid overdose among all opioid users (adjusted OR = 2.14; 95% CI, 2.05-2.24; P < .001), compared with opioid users who did not use benzodiazepines.

Intermittent opioid users had an adjusted odds ratio for an ED visit or inpatient admission for opioid overdose of 1.42 (95% CI, 1.33-1.51; P < .001) vs. 1.81 (95% CI, 1.67-1.96; P < .001) among chronic opioid users.

If the association is causal, eliminating concurrent use of opioids and benzodiazepines could reduce risk for ED visits and inpatient admissions for overdose by approximately 15%, according to researchers.

“Sun and colleagues found an alarming rise in this prescribing practice in their study population, from 9% in 2001 to 17% in 2013. They report a significantly increased risk of overdose among patients receiving both drug types concurrently, documenting one type of harm associated with this unsound and growing clinical practice,” Pinar Karaca-Mandic, PhD, of University of Minnesota School of Public Health, and colleagues wrote in an accompanying editorial. “A multi-pronged effort from both regulators and experts writing clinical guidelines, along with extensive expansion in warnings about the hazards of drug-drug interactions, are essential to reduce low value, potentially dangerous care.” – by Amanda Oldt

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Disclosure: Sun and colleagues report receiving support from grants from the Foundation for Anesthesia Education and Research. Please see the study for a full list of relevant financial disclosures.