Overlapping Opioid and Benzodiazepine Prescriptions in Chronic Pain: Rates and Related Outcomes

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Of 517 patients, 127 participants (24.6%) had been prescribed both benzodiazepine and long-term opioids in the year after their diagnosis.
Of 517 patients, 127 participants (24.6%) had been prescribed both benzodiazepine and long-term opioids in the year after their diagnosis.

Concurrent use of benzodiazepines and long-term opioids was found in 25% of patients with chronic pain, as well as to be associated with elevated risk of falling and visiting the emergency department, in a study published in Pain Medicine.

To evaluate the correlates and odds of receiving prescriptions for both benzodiazepine and long-term opioids, researchers conducted a cross-sectional study of 517 patients (average age, 59.4 years) from 2 hospital sites who had prior-year musculoskeletal pain diagnoses and current long-term opioid prescriptions. They also sought to determine the likelihood of adverse outcomes related to co-prescription, such as falls and visits to the emergency department.

Of 517 patients, 127 participants (24.6%) had been prescribed both benzodiazepine and long-term opioids in the year after their diagnosis, with an average polypharmacy duration of 7.6 months. Participants who had been prescribed opioids plus benzodiazepines vs opioids alone were primarily women and had higher overall comorbidity scores (5.1 vs 4.2, respectively; P <.001).

After controlling for confounding factors, the presence of a psychiatric diagnosis was found to be the only variable significantly associated with concurrent prescription of opioids and benzodiazepine. In this cohort, patients were more often prescribed both drugs if they had recently been diagnosed with anxiety disorder (adjusted odds ratio, 4.71; P <.001), posttraumatic stress disorder (adjusted odds ratio, 2.24; P =.019), or bipolar disorder (adjusted odds ratio, 3.82; P =.005).

Participants with prescriptions for both opioids and benzodiazepines vs opioids alone were found to experience 3.27 times more falls in the 3 months before the study (P <.001), and to be 1.66 times more likely to visit the emergency room in the year preceding the study period.

Study limitations include a low recruitment rate (<30%), with unenrolled patients in older age groups and men in the majority, and an inability to generalize results or evaluate overlapping use over time.

"Our study adds to growing evidence that individuals prescribed [long-term opioid therapy] not only commonly receive co-prescribed benzodiazepines," the researchers said, "but also have additional comorbidities and significant risk factors."

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Reference

Yarborough BJH, et al. Correlates of benzodiazepine use and adverse outcomes among patients with chronic pain prescribed long-term opioid therapy [published online September 10, 2018]. Pain Med. doi: 10.1093/pm/pny179

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