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 Benzodiazepines, which can treat anxiety, insomnia, seizures and
other problems, "are widely used by patients and most of them
probably do not realize how easy it is to accidentally overdose when
they are also prescribed an opioid," Dr. Joseph Ladapo of the
University of California, Los Angeles, told Reuters Health.
"I have taken care of patients who have been admitted to the
hospital for exactly this reason," he said by email, "and none of
them seemed to know how risky it was to be concurrently using both
benzodiazepines and opioids."
And although clinicians are aware of the overdose risks associated
with this combination, he said, "as a population, we probably
under-recognize it."
Dr. Ladapo and colleagues analyzed data from 2005 to 2015 on adults
20 years or older who received a new opioid prescription while
concurrently taking a benzodiazepine.
Popular benzodiazepines include diazepam (Valium), lorazepam (Ativan)
and alprazolam (Xanax).
As reported in JAMA Psychiatry and at the 2018 Society of General
Internal Medicine Annual Meeting in Denver, the annual number of
adults with a new opioid prescription who reported using
benzodiazepines during the study period rose from 7.3 million to
13.0 million.
Rates of new opioid prescriptions among adults using a
benzodiazepine increased from 189 to 351 per 1,000 persons between
2005 and 2010 and then decreased to 172 per 1,000 persons by 2015.
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After accounting for demographic characteristics and other medical
conditions (including cancer, back pain, headache, musculoskeletal
pain, injuries), the likelihood of receiving a new opioid
prescription during an ambulatory visit was still 83 percent higher
for patients using benzodiazepines compared with the general
population.
Naloxone, which has been recommended by the Surgeon General as an
antidote to opioid overdose, was coprescribed in less than 1 percent
of visits when a patient also used a benzodiazepine.
"Physicians should reduce the rates at which they prescribe opioids
to patients using sedatives," Dr. Ladapo said. "The 'right' level is
not zero but it is lower than what we are currently doing."
In email to Reuters Health, Dr. Arthur Williams of the Division of
Substance Use Disorders at Columbia University Irving Medical Center
in New York City agreed that "a simplistic guideline to not
co-prescribe opioids with benzodiazepines risks abandoning patients
in the greatest clinical need."
"A much more effective response," he suggested, would likely include
shifting patients who use benzodiazepines away from full-strength
opioids to painkillers with a much lower risk of respiratory
suppression and overdose.
SOURCE: http://bit.ly/2JUjx0W JAMA Psychiatry, online April 11,
2018.
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