Opioid, Benzodiazepine Coprescribing Increases Overdose Risk

Although coprescripting these two pain medications may be appropriate in some situations, complex pharmacokinetic interactions with concurrent use increases adverse effect risk.

Nonmedical use-related emergency department (ED) visits and drug overdose deaths from the combination of opioids and benzodiazepines tripled in the United States from 2004 to 2011, investigators reported in the American Journal of Preventive Medicine.1 

Researchers Christopher Jones, PharmD, and Jana McAninch, MD, analyzed records from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Drug Abuse Warning Network Emergency Department (DAWN ED) to determine trends in nonmedical use–related ED visits involving both opioid analgesics and benzodiazepines. They found that the rate of ED visits caused by or related to the non-medical combination of agents from those drug classes increased from 11 to 34.2 per 100,000 population from 2004 to 2011 (P-trend <0.0001), representing an average annual percentage change of 19.1%.

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They then performed a parallel analysis of data from the National Vital Statistics multiple cause-of-death file, which contains information abstracted from death certificates filed in state vital statistics offices. Overdose deaths involving both drug classes increased from 0.6 to 1.7 per 100,000 (P-trend <0.0001), an average annual percentage change of 15%, the researchers found. Opioid overdose deaths in which benzodiazepines were involved increased from 18% to 31%  (P-trend <0.0001) of all opioid analgesic overdose deaths from 2004 to 2011.

“The trends that we found are consistent with research that shows that the combined use of opioids and benzodiazepines is a risk factor for overdose mortality and morbidity,” Dr. Jones told Clinical Pain Advisor

In a 2013 JAMA study, Jones and colleagues found that among overdose deaths involving opioid analgesics, 30.1% also involved benzodiazepines.2 In demographic analyses, statistically significant increases for ED visits from 2004 to 2011 were observed in males and females, non-Hispanic whites, non-Hispanic blacks, and Hispanics, and in all age groups except 12- to 17-year-olds.