Concurrent Opioid and Benzodiazepine Use Associated with Increased Overdose Risk




Concurrent use of opioid and benzodiazepine increased by approximately 80% from 2001 to 2013, and the increase was associated with a significant increase in opioid overdose-related hospital admissions and emergency department visits for privately insured patients, according to a new study.

Researchers performed a retrospective analysis of concurrent benzodiazepine and opioid use trends using claims data from 315,428 privately insured individuals between 18 and 64 years of age who were continuously enrolled in a health care plan with medical and pharmacy benefits and filled at least 1 opioid prescription.
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Their findings showed an 80% relative increase of concurrent use of opioid and benzodiazepine from 9% in 2001 to 17% in 2015. The increase was mainly driven by intermittent opioid users, rather than chronic opioid users.

Individuals who took both benzodiazepine and an opioid had an increased risk for an emergency room visit or hospital admission for opioid overdose compared with opioid users who did not take benzodiazepine (adjusted odds ratio 2.14, 95% confidence interval 2.05 to 2.24; P<0.001). Specifically, the adjusted odds ratio for an emergency room visit or hospital admission due to opioid overdose was 1.42 (1.33 to 1.51; P<0.001) for intermittent opioid users and 1.81 (1.67 to 1.96; P<0.001) for chronic opioid users.

According to the researchers, if the association is causal, an estimated 15% of emergency room visits or hospital admissions for opioid overdose could potentially be avoided with the elimination of concurrent benzodiazepine and opioid use (95% confidence interval 14 to 16).

“Providers should exercise caution in prescribing opioids for patients who are already using benzodiazepines (or vice versa), even in a non-chronic setting. Indeed, we note that the association between concurrent benzodiazepine/opioid use and the risk of opioid overdose was broadly similar for both intermittent and chronic opioid users,” the researchers concluded.

—Melissa Weiss


Sun EC, Dixit A, Humphreys K, Darnall BD, Baker LC, and Mackey S. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis [published online March 14, 2017]. BMJ.