Opioid and Benzodiazepine Co-Use at the ED May Have Long-Term Negative Health Impacts

Brief exposure to opioids and benzodiazepines in emergency traumatic injury care may have long-term substance use and negative mental health outcomes.

Brief exposure to opioids and benzodiazepines in emergency traumatic injury care may be associated with long-term substance use and negative mental health outcomes, according to results of a study published in Drug and Alcohol Dependence.

The data for this study were sourced from the MetroHealth System which is a large health care system located in Ohio. Patients (N=13,804) who had an emergency department (ED) encounter for a traumatic injury between 1998 and 2015 were evaluated for benzodiazepine and opioid exposure in the ED. Five-year risk for substance use and negative mental health outcomes were evaluated among patients exposed to opioids (n=2686) and patients exposed to opioids and benzodiazepines (n=1227) and matched unexposed controls. The cohort exposed to opioids and benzodiazepines was also matched with a cohort of patients exposed to opioids.

Overall, the study population had a mean age of 46.0 (SD, 20.1) years, 30.7% were women, 69.3% were White, BMI was 28.3 (SD, 6.8) kg/m2, and they lived in an area with a median income of $46,020. The cohorts and their matched control groups were well balanced, except that the opioid-exposed group was older (P <.001) and had more women (P <.05) than their control group.

Opioid exposure was associated with decreased risk for nontobacco substance use (adjusted odds ratio [aOR], 0.27; 95% CI, 0.16-0.44), alcohol-related diagnoses (aOR, 0.08; 95% CI, 0.04-0.16), depression (aOR, 0.33; 95% CI, 0.24-0.46), and anxiety (aOR, 0.42; 95% CI, 0.28-0.61) 1 month to 5 years after the ED encounter.

Opioid and benzodiazepine co-use was associated with increased risk for anxiety compared with no medication exposure (aOR, 1.85; 95% CI, 1.37-2.49). Compared with opioid exposure only, co-use was associated with increased risk for nontobacco substance use (aOR, 2.65; 95% CI, 1.50-4.69), alcohol-related diagnoses (aOR, 4.02; 95% CI, 1.82-8.90), depression (aOR, 1.62; 95% CI, 1.21-2.16), and anxiety (aOR, 2.60; 95% CI, 1.86-3.65).

These data may have been biased, as the matched controls tended to have differing types and severity of presenting injuries.

The study authors concluded, “Overall, our results indicate that, although receiving opioids during an emergency department visit for traumatic injury care predicted a relatively lower likelihood of subsequent substance use and mental health disorders, the acute co-prescription of benzodiazepines and opioids was strongly associated with a variety of poor health outcomes. Future purpose-built investigations are required before strong conclusions can be made.”

Disclosure: One author is the chief medical informatics officer of the MetroHealth System. Please refer to the original article for further information.

This article originally appeared on Psychiatry Advisor

References:

Sprunger JG, Johnson K, Lewis D, Kaelber DC, Winhusen TJ. Five-year incidence of substance use and mental health diagnoses following exposure to opioids or opioids with benzodiazepines during an emergency department encounter for traumatic injury. Drug Alcohol Depend. 2022;238:109584. doi:10.1016/j.drugalcdep.2022.109584