Data presented by researchers at Prime Therapeutics at the 2017 Academy of Managed Care Pharmacy annual spring meeting reveals that up to 25% of people with commercial insurance who are prescribed opioid painkillers are also given benzodiazepines concurrently.
This, despite evidence that combined use can contribute to life-threatening central nervous system depression, especially in older people. Indeed, there has been considerable regulatory activity of late that seeks to battle the problem of simultaneous use, such as a 2016 recommendation from the Centers for Disease Control and Prevention to avoid prescribing the combination:
“Experts agreed that although there are circumstances when it might be appropriate to prescribe opioids to a patient receiving benzodiazepines (e.g., severe acute pain in a patient taking long-term, stable low-dose benzodiazepine therapy), clinicians should avoid prescribing opioids and benzodiazepines concurrently whenever possible.”
Indeed, rates of emergency department visits and hospitalizations double due to overdose when these drugs are used in combination, according to another study. Also, opioid users who also used a benzodiazepine increased from 9% to 17% in 2013, although this result was “driven mainly by increases among intermittent, as opposed to chronic, opioid users.”
From the study:
“If this association is causal, elimination of concurrent benzodiazepine/opioid use could reduce the risk of emergency room visits related to opioid use and inpatient admissions for opioid overdose by an estimated 15%.”
Similarly, past research from Veterans Affairs found that 27% of patients from 2004-2009 who received painkillers were also prescribed benzodiazepines, and an estimated one-half of all deadly overdoses in that population occurred while patients were simultaneously prescribed both classes of drugs.
As part yet another study, researchers at Prime Therapeutics also presented data in which they identified more than 200 persons with commercial insurance whom they suspected were abusing a prescribed controlled substance. They then contacted their providers for a consultation.
Six months after initial contact, they discovered that those in the group in which they intervened had 6.4% less emergency room visits compared to controls prescribed similar drugs whose providers they did not contact.
While this intervention did not specifically target persons using both benzodiazepines and opioids, researchers noted that they type of initiatives can help address the problem.
Discontinuing Combined Use of Benzo and Opioids
Of stark importance, the CDC states that patients receiving both drugs should be put on a tapering schedule for opioids first since a reduction in opioid use can lead to more anxiety. Also, benzos should be tapered slowly to avoid rebound anxiety, hallucinations, seizures, etc.
The agency recommends using a weaning schedule that consists of reducing the benzo dose by 25% every 1-2 weeks and notes that cognitive-behavioral therapy that addresses anxiety may be beneficial in increasing the success of tapering from benzodiazepines.