Opioid-Benzo Combo Raises Deadly Drug Overdose Risk

Concurrently prescribed opioids and benzodiazepines increase the risk for deadly drug overdose in veterans.

A new study published in the British Medical Journal found 27% of US veterans who received opioids between 2004 and 2009 were taking benzodiazepines at the same time. Roughly half of the drug overdose deaths among that population occurred when the drugs were prescribed concurrently, and veterans’ risk of fatal drug overdose grew as their daily benzodiazepines doses increased.

Lead study author Tae Woo Park, MD, Msc, told Pharmacy Times in an exclusive interview how pharmacists can apply these alarming findings to their practice.

“Pharmacists can play an important role in helping prevent unintended consequences of combined benzodiazepine and opioid analgesic use,” explained Dr. Park, an assistant professor at the Warren Alpert Medical School of Brown University. “They can alert providers when patients are receiving high doses of these medications and possibly recommend naloxone distribution for these patients. They can also help identify multiple providers of these medications, possibly with help from prescription monitoring programs when available.”

The most commonly prescribed benzodiazepines in the study were on the Veterans Health Administration’s drug formulary, which includes alprazolam, chlordiazepoxide, clonazepam, diazepam, lorazepam, and temazepam. The opioids examined in the study were codeine, morphine, oxycodone, hydrocodone, oxymorphone, hydromorphone, fentanyl, propoxyphene, and methadone.

Veterans who received benzodiazepines were more likely to be women, middle-aged, white, and to live in wealthier areas. They were also more likely to have a history of mental health or substance abuse.

Of all fatal overdoses involving pharmaceuticals in 2010, 75% were tied to opioid analgesics, the researchers cited. In addition, 30% of drug overdose deaths involving opioids were related to the concomitant use of benzodiazepines.

“[D]rug overdoses are a leading cause of death in the United States, and prescribing benzodiazepines to patients taking opioids for pain is quite common,” said Dr. Park in a press release. “As we learn more about pharmaceuticals and how they interact with each other, we can try to reduce the risk of harm to patients.”