Should Drug Testing Be Implemented Before Prescribing Opioids and Benzodiazepines?

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One in 6 patients who tested positive for opioid prescriptions also tested positive for nonprescribed benzodiazepine drugs.
One in 6 patients who tested positive for opioid prescriptions also tested positive for nonprescribed benzodiazepine drugs.

The following article is part of conference coverage from the PAINWeek 2018 conference in Las Vegas, Nevada. Clinical Pain Advisor's staff will be reporting breaking news associated with research conducted by leading experts in pain medicine. Check back for the latest news from PAINWeek 2018.

LAS VEGAS — Clinicians should get their patients tested for drugs before prescribing them opioid or benzodiazepine medications—and on a regular basis when patients are on those drugs—as drug-drug interactions may be associated with risks, according to a study presented during the 2018 PAINWeek conference, held September 4-8.

"Opioid-related morbidity and mortality are well recognized issues in the United States, but unlike opioid prescribing, which has stabilized or decreased, benzodiazepine prescribing continues to rise," the researchers wrote. "For 2015, more than 30% of the estimated 33,000 opioid-related deaths also involved benzodiazepines. From 2002 to 2015 there was a 4.3-fold increase in the total number of benzodiazepine-related deaths."

A total of 276,953 patients prescribed ≥1 drug and who were tested by a national reference laboratory for opioid analgesics and benzodiazepines were included in the analysis (>456,675 test results). Of 95,648 patients (20%) who tested positive for concurrent use of opioids and benzodiazepines, 34,059 (36%) were prescribed both classes of drugs, and 61,589 (64%) tested for at least 1 nonprescribed drug. One in 6 patients (16%) who tested positive for opioid prescriptions also tested positive for nonprescribed benzodiazepine drugs, and 13% of patients who tested positive for prescribed benzodiazepines also tested positive for nonprescribed opioid medications.

"Clinicians should be aware of potentially dangerous drug interactions including those of non-prescribed agents," the authors noted. "The extent of concurrent use of benzodiazepines and opioids, particularly non-prescribed use, cannot be determined by prescription drug database monitoring programs, suggesting the need for more effective clinician assessment and intervention. Our results support the Centers for Disease Control and Prevention opioid prescribing guidelines, which indicate that drug testing should occur before and periodically throughout opioid use and that testing should be extended to patients prescribed benzodiazepines as well."



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Reference

Gudin J, McClure FL, Niles J, Kaufman H. Concurrent use of opioid and benzodiazepine: What the Prescription Drug Monitoring database does not tell you. Presented at: PAINWeek 2018; September 4-8, 2018; Las Vegas, Nevada. Poster 44.

For more coverage of PAINWeek 2018, click here.

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