Overdose risk quintuples with opioid and benzodiazepine use

June 22, 2018, University of Pittsburgh Schools of the Health Sciences

In the first 90 days of concurrent opioid and benzodiazepine use, the risk of opioid-related overdose increases five-fold compared to opioid-only use among Medicare recipients, according to a new study from the University of Pittsburgh School of Pharmacy, published today in JAMA Network Open.

The U.S. Centers for Disease Control and Prevention recommends against concurrent use of opioids and benzodiazepines, but nearly a quarter of Medicare recipients who are prescribed opioids also fill prescriptions for benzodiazepines. Both drugs have sedative effects.

"Patients who must be prescribed both an opioid and a should be closely monitored by due to an increased risk for , particularly in the early days of this medication regimen," said Inmaculada Hernandez, Pharm.D., Ph.D., assistant professor at Pitt's School of Pharmacy and the study's lead author. "Moving forward, should focus on preventing concurrent exposure instead of simply reducing the length of time patients use both drugs."

Hernandez and her team used 2013-2014 Medicare Part D data to assess how the duration of simultaneous exposure to the two types of drugs impacts the risk of overdose. Beneficiaries not being treated for cancer who filled at least one opioid prescription during that year were included in the analysis, which ultimately looked at more than 71,000 beneficiaries who averaged 66.5 years of age.

Patients were divided into two groups, those with a supply of only opioids the day before an overdose, and those with an opioid and benzodiazepine supply. The second group was then divided into four subgroups based on the cumulative number of days with overlapping opioid and benzodiazepine supplies.

For patients who did not have an overdose event in the first 90 days of concurrent use, overdose risk in the next 90 days decreased from five-fold to less than double, which is still elevated compared to opioid-only use. After 180 days of concurrent use, the risk of overdose was no higher than the risk for opioid-only use.

Results were adjusted to account for patient demographics, health insurance factors, clinical characteristics, and the number of unique clinicians who prescribed opioids or benzodiazepines to the patients.

Hernandez and her team also found that a beneficiary's risk of concurrent opioid and benzodiazepine use and of overdose increased with the numbers of and benzodiazepine prescribers. In other words, the more clinicians prescribing medications to a beneficiary, the higher the risk of that beneficiary overdosing.

"These findings demonstrate that fragmented care plays a role in the inappropriate use of opioids, and having multiple prescribers who are not in communication increases the risk for overdose," said Yuting Zhang, Ph.D., director, Pharmaceutical Economics Research Group, Health Policy and Management, Pitt Graduate School of Public Health, and the study's senior author. "Prescription monitoring programs and policy interventions can help curb this problem and reduce risk for ."

Explore further: Patterns of potential misuse help assess risk of opioid overdose

Related Stories

Patterns of potential misuse help assess risk of opioid overdose

May 22, 2018
(HealthDay)—Patterns of potential opioid misuse are positively associated with subsequent opioid overdose, according to a study published online May 22 in the Annals of Internal Medicine.

Combining opioids with anti-anxiety medicines linked to greater risk of overdose

March 14, 2017
Taking opioids (strong prescription painkillers) together with benzodiazepines (widely used to treat anxiety and sleep problems) is associated with greater risk of opioid overdose, finds a study in The BMJ today.

Older age, ICU, poor renal fcn up risk of opioid OD in hospital

June 13, 2018
(HealthDay)—Risk factors for opioid overdose among hospitalized patients include being age 65 years or older, being in an intensive care unit (ICU), and having renal impairment, according to a study published online May ...

Risky opioid prescriptions linked to higher chance of death

June 18, 2018
When patients are prescribed opioids in risky ways, their chance of dying increases and their odds of death go higher as the number of risky opioid prescriptions increase, according to a new RAND Corporation study.

Medicaid patients continue high prescription opioid use after overdose

August 22, 2017
Despite receiving medical attention for an overdose, patients in Pennsylvania Medicaid continued to have persistently high prescription opioid use, with only slight increases in use of medication-assisted treatment, according ...

Doctors prescribe opioids at high rates to those at increased overdose risk

April 24, 2018
The number of first-time prescriptions for opioid drugs has not risen since about 2010, according to UCLA researchers. However, patients taking a class of drug known to increase the risk for overdoses were likelier to receive ...

Recommended for you

FDA recalls heart medication valsartan, citing cancer concerns

July 17, 2018
The U.S. Food and Drug Administration issued a voluntary recall of several medications that contain the active ingredient valsartan, which is used to treat high blood pressure and heart failure.

Opioids given too easily to children: study

July 16, 2018
(HealthDay)—Many children are prescribed powerful opioid painkillers they don't really need, putting them and those around them at risk, a new study shows.

Study reveals opioid patients face multiple barriers to treatment

July 12, 2018
In areas of the country disproportionately affected by the opioid crisis, treatment programs are less likely to accept patients paying through insurance of any type or accept pregnant women, a new Vanderbilt study found.

Report details possible conflict of interest issues for FDA advisors

July 6, 2018
Charles Piller, a contributing correspondent for the journal Science, has published a Feature piece in the journal detailing what he describes as possible conflicts of interest issues by people who serve as advisors to the ...

Opioid epidemic responses overlook gender

July 5, 2018
Yale health experts warn that current efforts to confront the growth of opioid addiction and overdose deaths must better incorporate an understanding of how women fit into this epidemic.

Study finds no strong evidence that cannabis reduces chronic pain

July 4, 2018
A four-year study suggests medicinal cannabis is not as effective at relieving chronic non-cancer pain as commonly assumed.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.