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?
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.