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Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis.

Abstract Objectives To identify trends in concurrent use of a benzodiazepine and an opioid and to identify the impact of these trends on admissions to hospital and emergency room visits for opioid overdose.Design Retrospective analysis of claims data, 2001-13.Setting Administrative health claims database.Participants 315 428 privately insured people aged 18-64 who were continuously enrolled in a health plan with medical and pharmacy benefits during the study period and who also filled at least one prescription for an opioid.Interventions Concurrent benzodiazepine/opioid use, defined as an overlap of at least one day in the time periods covered by prescriptions for each drug. Main outcome measures Annual percentage of opioid users with concurrent benzodiazepine use; annual incidence of visits to emergency room and inpatient admissions for opioid overdose.Results 9% of opioid users also used a benzodiazepine in 2001, increasing to 17% in 2013 (80% relative increase). This increase was driven mainly by increases among intermittent, as opposed to chronic, opioid users. Compared with opioid users who did not use benzodiazepines, concurrent use of both drugs was associated with an increased risk of an emergency room visit or inpatient admission for opioid overdose (adjusted odds ratio 2.14, 95% confidence interval 2.05 to 2.24; P<0.001) among all opioid users. The adjusted odds ratio for an emergency room visit or inpatient admission for opioid overdose was 1.42 (1.33 to 1.51; P<0.001) for intermittent opioid users and 1.81 (1.67 to 1.96; P<0.001) chronic opioid users. 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% (95% confidence interval 14 to 16).Conclusions From 2001 to 2013, concurrent benzodiazepine/opioid use sharply increased in a large sample of privately insured patients in the US and significantly contributed to the overall population risk of opioid overdose.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title bmj (clinical research ed.)
Publication Year Start




PMID- 28292769
OWN - NLM
STAT- MEDLINE
DA  - 20170315
DCOM- 20170406
LR  - 20170406
IS  - 1756-1833 (Electronic)
IS  - 0959-535X (Linking)
VI  - 356
DP  - 2017 Mar 14
TI  - Association between concurrent use of prescription opioids and benzodiazepines
      and overdose: retrospective analysis.
PG  - j760
LID - 10.1136/bmj.j760 [doi]
AB  - Objectives To identify trends in concurrent use of a benzodiazepine and an opioid
      and to identify the impact of these trends on admissions to hospital and
      emergency room visits for opioid overdose.Design Retrospective analysis of claims
      data, 2001-13.Setting Administrative health claims database.Participants 315 428 
      privately insured people aged 18-64 who were continuously enrolled in a health
      plan with medical and pharmacy benefits during the study period and who also
      filled at least one prescription for an opioid.Interventions Concurrent
      benzodiazepine/opioid use, defined as an overlap of at least one day in the time 
      periods covered by prescriptions for each drug. Main outcome measures Annual
      percentage of opioid users with concurrent benzodiazepine use; annual incidence
      of visits to emergency room and inpatient admissions for opioid overdose.Results 
      9% of opioid users also used a benzodiazepine in 2001, increasing to 17% in 2013 
      (80% relative increase). This increase was driven mainly by increases among
      intermittent, as opposed to chronic, opioid users. Compared with opioid users who
      did not use benzodiazepines, concurrent use of both drugs was associated with an 
      increased risk of an emergency room visit or inpatient admission for opioid
      overdose (adjusted odds ratio 2.14, 95% confidence interval 2.05 to 2.24;
      P&lt;0.001) among all opioid users. The adjusted odds ratio for an emergency room
      visit or inpatient admission for opioid overdose was 1.42 (1.33 to 1.51; P&lt;0.001)
      for intermittent opioid users and 1.81 (1.67 to 1.96; P&lt;0.001) chronic opioid
      users. 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%
      (95% confidence interval 14 to 16).Conclusions From 2001 to 2013, concurrent
      benzodiazepine/opioid use sharply increased in a large sample of privately
      insured patients in the US and significantly contributed to the overall
      population risk of opioid overdose.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Sun, Eric C
AU  - Sun EC
AD  - Department of Anesthesiology, Perioperative and Pain Medicine, Stanford
      University School of Medicine, 300 Pasteur Dr, H3580, Stanford, CA 94305, USA.
FAU - Dixit, Anjali
AU  - Dixit A
AD  - Department of Anesthesiology and Perioperative Care, University of California,
      San Francisco, 521 Parnassus Ave, San Francisco, CA 94131, USA.
FAU - Humphreys, Keith
AU  - Humphreys K
AD  - Center for Innovation to Implementation, VA Palo Alto Health Care System and
      Department of Psychiatry, Stanford University School of Medicine, Stanford
      University, 401 N Quarry Road, MC:5717, Stanford, CA 94305, USA.
FAU - Darnall, Beth D
AU  - Darnall BD
AD  - Department of Anesthesiology, Perioperative and Pain Medicine, Stanford
      University School of Medicine, 300 Pasteur Dr, H3580, Stanford, CA 94305, USA.
FAU - Baker, Laurence C
AU  - Baker LC
AD  - Department of Health Research and Policy, Stanford University School of Medicine,
      Stanford University and National Bureau of Economic Research, 150 Governor's
      Lane, HRP Redwood Building, Stanford, CA 94305, USA.
FAU - Mackey, Sean
AU  - Mackey S
AD  - Department of Anesthesiology, Perioperative and Pain Medicine, Stanford
      University School of Medicine, 300 Pasteur Dr, H3580, Stanford, CA 94305, USA.
LA  - eng
PT  - Journal Article
DEP - 20170314
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
RN  - 0 (Analgesics, Opioid)
RN  - 12794-10-4 (Benzodiazepines)
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Analgesics, Opioid/adverse effects/*therapeutic use
MH  - Benzodiazepines/adverse effects/*therapeutic use
MH  - Drug Overdose/*epidemiology/therapy
MH  - Emergency Medical Services/statistics &amp; numerical data
MH  - Female
MH  - For-Profit Insurance Plans/statistics &amp; numerical data
MH  - Hospitalization/statistics &amp; numerical data
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Polypharmacy
MH  - Prevalence
MH  - Retrospective Studies
MH  - Risk Factors
MH  - United States/epidemiology
MH  - Young Adult
EDAT- 2017/03/16 06:00
MHDA- 2017/04/07 06:00
CRDT- 2017/03/16 06:00
PST - epublish
SO  - BMJ. 2017 Mar 14;356:j760. doi: 10.1136/bmj.j760.

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