More Evidence that Concurrent Opioid and Benzodiazepine Use Increases Risk of Overdose

Clinical guidelines recommend that clinicians avoid prescribing opioids and benzodiazepines concurrently. In this study, researchers used national health claims data from 315,428 privately insured adults who received at least 1 opioid prescription to assess the association of concurrent opioid and benzodiazepine prescriptions with emergency department and inpatient admission for opioid overdose. Concurrent opioid and benzodiazepine prescription was defined as overlap of at least 1 day in prescription coverage.

  • The concurrent use of opioids and benzodiazepines rose from 9% in 2001 to 17% in 2013.
  • In analyses adjusted for year, age, sex, and co-morbid conditions, concurrent opioid and benzodiazepine use was associated with increased risk for overdose among all people with opioid use (odds ratio [OR], 2.14), those with intermittent use (OR, 1.42), and those with chronic use (OR, 1.81), when compared with people with opioid use who did not have benzodiazepine use.
  • Results did not change substantially if the degree of time overlap for concurrent prescription was increased from 1 day to >25% overlap.
  • The researchers estimated that the elimination of concurrent opioid and benzodiazepine prescribing would lower emergency department and inpatient admissions for overdose by about 15%.

Comments: This study provides more evidence of increased risk for opioid overdose with concurrent use of opioids and benzodiazepines, this time in a privately insured adult population. Equally worrisome is the near doubling in prevalence of concurrent use from 2001 to 2013. Prescribers and patients need to be better informed about the risk of using opioids and benzodiazepines concurrently.

Kevin L. Kraemer, MD, MSc

Reference: Sun EC, Dixit A, Humphreys K, et al. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ. 2017;356:j760.


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