Study on Concurrent Benzodiazepine and Opioid Use
Research Overview
Researchers from Stanford University conducted an analysis of health insurance claims from 2001 to 2013 to explore the relationship between concurrent benzodiazepine and opioid use, and the risk of opioid overdose. The study revealed a notable increase in both the incidence of concurrent medication use and the associated risk of overdose among patients taking both types of drugs.
Opioid Crisis in the United States
Opioid abuse remains a significant issue in the United States, with approximately 2.1 million individuals misusing prescription opioids. Since 1999, deaths resulting from opioid overdoses have surged fourfold. While opioids can effectively manage pain when prescribed appropriately, their misuse can lead to addiction and potentially fatal consequences.
Prescription Trends
Over the last 15 years, prescriptions for opioids—such as oxycodone, hydromorphone, and codeine—have increased by nearly 300%. In contrast, benzodiazepines (BZDs), including medications like diazepam and lorazepam, are commonly prescribed for various conditions, including insomnia, muscle spasms, anxiety, and seizures.
FDA Warnings
Given the risks associated with concurrent BZD and opioid use, including heightened respiratory suppression, the FDA has issued a black box warning regarding the dangers of using these two classes of medications simultaneously. Approximately 30% of fatal opioid overdoses involve the use of a BZD.
Study Findings
In a recently published article in the BMJ, Stanford investigators performed a retrospective analysis using private insurance claims to assess the relationship between opioid and BZD use in overdose cases that resulted in emergency room visits. The study utilized data from Marketscan, which encompasses 35 million patients with private insurance.
Researchers focused on patients aged 18 to 64 who had continuous insurance coverage from January 1, 2001, to December 31, 2013, and who filled at least one opioid prescription, excluding opioid-based cough medications. Patients with a history of cancer were not included in the study. The analysis identified overlaps in BZD and opioid use and employed statistical methods to determine the correlation with opioid overdoses.
Key Outcomes
The primary outcomes measured included the percentage of opioid users with overlapping BZD usage, the frequency of emergency room visits for opioid overdoses, and the rate of inpatient admissions due to opioid overdoses. The study found that the incidence of simultaneous use of BZDs and opioids increased by approximately 80% from 2001 to 2013. Additionally, the rates of hospitalizations and emergency room visits among patients using both medications were significantly higher. The researchers estimated that a 15% reduction in overdoses could be achieved by discontinuing the concurrent use of BZDs and opioids.
Limitations and Recommendations
The study’s inclusion criteria of continuous coverage may limit the findings, as some patients may have died from opioid overdoses during the study period, potentially skewing the overall incidence of overdoses. Furthermore, the researchers could not account for illegal drug use. The authors intend for their findings to highlight the dangers of combining BZDs and opioids, advocating for the development of educational programs to inform prescribers about risky prescribing patterns.
Conclusion
This research underscores the critical need for awareness and caution regarding the concurrent use of benzodiazepines and opioids, given the significant risks of overdose and the ongoing opioid crisis in the United States.