In 2013, 17% of opioid users were concurrently prescribed benzodiazepines, an 80% relative increase from 2001. Concurrent use of both drugs is associated with an increased risk of an emergency room visit or inpatient admission for opioid overdose (adjusted odds ratio 2.14). This is particularly concerning because opioids and benzodiazepines are the most common prescription classes involved in pharmaceutical overdoses, with opioids implicated in 75.2% and benzodiazepines in 29.4% of all pharmaceutical overdoses, and benzodiazepines were involved in 30% of opioid-related overdoses (2010/2011). Similar trends have been identified in veteran and non-veteran populations.
Clinical practice guidelines (CPG) that recommend caution in co-prescribing of opioid and benzodiazepines due to the significantly increased risk of adverse events including lethal opioid overdoses. Most primary care providers and mental health experts agree with these recommendations and express significant concern about such prescribing practices. Despite such agreement, most struggle with abiding with such recommendations because of patients’ resistance, the apparent clinical stability of the patient and not wanting to “rock the boat” and because they worry that discontinuing either treatment would be complicated. Most prescribers found that prescribers rated strategies for addressing patients who refuse to discontinue, more time with patients, and identification of high-risk patients would be helpful in reducing such dangerous prescribing practices.
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