Benzodiazepine Use May Increase Risk of Opioid Misuse.
Combined opioid and benzodiazepine use has become more common in both hospital emergency department visits and in drug overdoses.
Now, a new study co-authored by School of Public Health researchers suggests that use of benzodiazepines—anti-anxiety agents, muscle relaxants, and sedatives—increases the risk of early opioid refills and may contribute to opioid misuse.
The study, in the journal Substance Abuse, looked at medical records of about 850 patients receiving chronic opioid therapy at three primary care clinics. Of that group, about 23 percent received at least one benzodiazepine prescription during the study period. Those who were on benzodiazepines were more likely to have gotten an early opioid refill—defined as a prescription written 7 to 25 days after the previous one—than those who were not.
Patients who received benzodiazepines were more likely to be female, white, and have a diagnosis of a depressive, anxiety, or other psychiatric disorder, the study says.
The study also looked at whether benzodiazepine receipt was a marker for illicit cocaine use in patients using opioids. No association with cocaine was found.
The authors proposed several explanations for the link between benzodiazepine use and early opioid refills, including that benzodiazepines may produce “a euphoric effect” when combined with opioids, or that receipt of a benzodiazepine prescription may be “a marker for more severe pain” or low pain tolerance.
“Benzodiazepine prescription may best be conceived of as a marker for addictive behaviors, low pain tolerance or higher pain severity in this population,” the study concludes. “Because alternative therapies exist for the primary indications for benzodiazepine prescription, further research should better elucidate the risks and benefits of prescribing benzodiazepines to patients receiving opioids for pain.”
Co-authors on the study include Richard Saitz, professor and chair of community health sciences, Ziming Xuan, assistant professor of community health sciences, Kerrie Nelson, research associate professor of biostatistics, Karen Lasser, associate professor of community health sciences and of medicine at the School of Medicine, and Jane Liebschutz, associate professor of medicine at MED. The study was led by Tae Woo Park, an assistant professor of medicine and psychiatry at Brown University’s Alpert Medical School.