Association between concurrent use of prescription opiates and benzos


Title: Short periods of concurrent benzodiazepine and opioid use increase overdose risk

Clinical Question: What is the impact of concurrent benzodiazepine use in chronic versus intermittent opioid use on risk for opioid overdose?

Dr. Eileen Barrett, assistant professor in the division of hospital medicine at the University of New Mexico

Dr. Eileen Barrett

Background: Previous studies have described the increased risk of fatal opioid overdose with benzodiazepine co-prescription, but have not quantified the difference in risk for overdose from intermittent versus chronic opioid use.

Study Design: Retrospective study.

Setting: Private insurance administrative claims in the United States.

Synopsis: In 315,428 privately insured adults younger than 65 without malignancy who filled at least one opioid prescription between 2001 and 2013, concurrent benzodiazepine use doubled (increasing from 9% to 17%) and was associated with an increased risk for hospitalization for opioid overdose (1.16% versus 2.42%, odds ratio = 2.14, P less than .001). The risk was increased in both chronic opioid users versus nonusers (5.36% versus 3.13%, odds ratio = 1.8, CI, 1.67-1.96, P less than .001) and in intermittent opioid users as compared to nonusers (1.45% versus 1.02%, odds ratio = 1.42, CI, 1.33-1.51, P less than .001).

These results are similar to prior studies performed in other patient populations, but add to those by including short periods of co-prescription between opioid and benzodiazepine prescriptions (including a single day of overlap). Limitations of this study include that it included only patients who were seen in the ED or hospital.

Bottom Line: There may be no safe duration of opioid use in patients who are also taking benzodiazepines.

Citation: Sun EC, Dixit, A, Humphreys K, et. al. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ 2017;356(760):1-7.

Dr. Barrett is assistant professor in the division of hospital medicine at the University of New Mexico.

Recommended Reading

Ventilator use in patients with advanced dementia
The Hospitalist
Use of second-generation antidepressants in older adults is associated with increased hospitalization with hyponatremia
The Hospitalist
Work-life balance is not a ‘thing’ but alignment is
The Hospitalist
Interventions, especially those that are organization-directed, reduce burnout in physicians
The Hospitalist
Hospitalist burnout
The Hospitalist
   Comments ()