People who take opioids together with benzodiazepines are placing themselves at a raised risk of overdose, new research shows.
Nearly 30% of fatal ‘opioid’ overdoses in the US also involve benzodiazepines, say Dr Eric Sun and colleagues at Stanford University, USA, in today’s (15 March) BMJ.
It is possible that the rise in opioid related deaths might be partly caused by increases in concurrent benzodiazepine/opioid use over time. So the team investigated a sample of 315,428 privately insured patients aged 18 to 64 years, followed from 2001 to 2013.
During this time, concurrent benzodiazepine/opioid prescribing increased by nearly 80%, and opioid users who also used benzodiazepines were at "substantially higher risk of an emergency room visit or inpatient admission for opioid overdose".
The authors believe that: "Elimination of the concurrent use of benzodiazepines and opioids could reduce the population risk of an emergency room visit or inpatient admission for opioid overdose by 15%."
They call for opioids to be prescribed cautiously in patients who are also taking benzodiazepines, and suggest that health care systems could implement education programmes to warn prescribers and patients about the risks of taking these drugs together. The current level of warnings and guidelines "are unlikely to change clinical behaviour, at least not quickly," they write.
"Unless systems are set up to push information to providers, busy clinicians will struggle to keep up with their patients’ use of different prescriptions," they warn, and recommend "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".
Sun, E. C. et al. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ 15 March 2017 doi: 10.1136/bmj.j760 [abstract]
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