March 29, 2017

Curbing this deadly drug combination could reduce opioid overdoses

Daily Briefing

    An individual's risk of overdosing on prescription opioids more than doubles if the individual also is taking benzodiazepines, according to a study published this month in BMJ, German Lopez reports for Vox.

    Benzodiazepine medications are most commonly prescribed to treat anxiety and mood disorders, such as depression and insomnia. The drugs also are used to treat seizures. Federal data show that benzodiazepines were involved in nearly 9,000 overdose deaths in 2015. According to Vox, most deaths involving benzodiazepines also involved opioids.  

    Study details

    For the study, researchers compared the risk of ED visits or impatient admissions among individuals who were prescribed only opioids and individuals who were prescribed both opioids and benzodiazepines. The researchers looked at health insurance claims data from 2001 through 2013 on nearly 320,000 privately insured adults ages 18 to 64.

    Key findings

    The researchers found that, in both 2001 and 2013, individuals who used both opioids and benzodiazepines were more likely to visit an ED or receive inpatient treatment for an opioid-related overdose than individuals who only used prescription opioids. According to the researchers:

    • 2.01 percent of individuals who used both prescription opioids and benzodiazepines visited an ED or received inpatient treatment for an opioid overdose in 2001, compared with 1.08 percent of individuals who used only prescription opioids; and

    • 3.99 percent of individuals who used both prescription opioids and benzodiazepines visited an ED or received inpatient treatment for an opioid overdose in 2013, compared with 1.35 percent of individuals who used only prescription opioids.

    Further, the researchers found the percentage of people who used both prescription opioids and benzodiazepines increased between 2001 and 2013. According to the researchers, 17 percent of individuals who used prescription opioids in 2013 also used benzodiazepines, up from 9 percent in 2001. The researchers wrote that the increase "significantly contributed to the overall population risk of opioid overdose."

    Discussion

    The researchers wrote that eliminating concurrent use of opioids and benzodiazepines could reduce the risk of opioid overdose-related ED and inpatient visits by 15 percent and potentially could have prevented an estimated 2,630 deaths related to opioid painkiller overdoses in 2015.

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    Keith Humphreys, a drug policy expert at Stanford University and a co-author of the study, said, "Even if we didn't change opioid prescribing at all, the data here suggest that we could cut overdoses dramatically just (by) getting prescribers to not put people on a benzodiazepine at the same time."

    But reducing concurrent prescribing could entail "tough trade-offs," Vox reports. For instance, individuals experiencing both pain and anxiety could be forced to seek an alternative treatment for one of the conditions to avoid being prescribed both an opioids and benzodiazepine medication, according to Vox (Lopez, Vox, 3/24; Sun et al., BMJ, 1/30).

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    See how five organizations have integrated pharmacists into their primary care teams to improve patient outcomes and reduce avoidable spending—and explore six critical components of an integrated pharmacy program.

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