Opioid Prescriptions Are Higher Among Patients Taking Benzodiazepines
Opioid prescription rates are higher among patients who are taking benzodiazepines compared with the general population, according to a new study.1
Benzodiazepines—or depressants such as alprazolam (Xanax) and diazepam (Valium) that are commonly prescribed for conditions including anxiety and insomnia—are increasingly misused and abused in the United States.2 Benzodiazepine overdoses can be fatal when mixed with opioids.
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For their study, the researchers evaluated 13,146 physician visits (representative of 214 million visits nationally) made by adults aged 20 years or older who received new opioid prescriptions while concomitantly using a benzodiazepine.
Analyses were performed using publicly available data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from January 1, 2005, through December 31, 2015.
Rates of new opioid prescriptions increased from 2005 to 2010 among adults using a benzodiazepine, rising from 189 to 351 per 1000 persons (rate difference 162). However, these rates later decreased to 172 per 1000 persons by 2015 (rate difference −179).
In the general population, new opioid prescriptions increased from 78 to 93 per 1000 persons from 2005 to 2010, and decreased to 79 per 1000 persons by 2015. However, neither of these figures reached significance.
Following adjustment for various factors—including diagnoses associated with pain—patients using a benzodiazepine were still more likely to receive a new opioid prescription during an ambulatory visit compared with the general population (adjusted relative risk 1.83).
“These patterns suggest that the recent increase in opioid-related deaths may be associated with factors other than physicians writing new opioid prescriptions,” the researchers wrote.
“Nevertheless, prescribing among higher-risk patients still occurred at rates higher than rates in the general population, representing an important opportunity to improve quality of care for patients experiencing pain,” they added.
Among patients concurrently using a benzodiazepine who received a new opioid prescription, naloxone was co-prescribed in less than 1% of visits.
—Christina Vogt
Reference:
1. Ladapo JA, Larochelle MR, Chen A, et al. Physician prescribing of opioids to patients at increased risk of overdose from benzodiazepine use in the United States. JAMA Psychiatry. 2018;75(6):623-630. doi:10.1001/jamapsychiatry.2018.0544
2. Drug fact sheet: benzodiazepines. Drug Enforcement Administration. https://www.dea.gov/druginfo/drug_data_sheets/Benzodiazepines.pdf