People with chronic pain often are prescribed benzodiazepines to treat anxiety, panic attacks, and other mental conditions that can be brought on by the stress of coping with their pain. But these people also are likelier to receive new opioid prescriptions for their pain than people who don’t use benzodiazepines, reports the University of California at Los Angeles (UCLA). Used in combination, the researchers noted, these drugs are known to sharply increase the risk of overdose.
According to the researchers, rates of new opioid prescriptions in the United States for people on benzodiazepine increased 86% from 189 to 351 per 1,000 people between 2005 and 2010. But the rate of new prescriptions for these patients fell 51% to 172 per 1,000 people by 2015. By contrast, new opioid prescriptions for patients who were not also taking benzodiazepines increased from 78 to 93 per 1,000 between 2005 and 2010 and dropped 15% to 79 per 1,000 by 2015.
Yet even with that drop in prescriptions, opioid-linked deaths increased from 5 per 100,000 people in the United States in 2005 to 11 per 100,000 in 2015 and continued to rise in 2017, according to the Centers for Disease Control and Prevention.
“We were surprised by how much higher the probability is of new opioid prescriptions to patients using benzodiazepines, considering that these patients face such an increased risk of overdose,” said senior author John Mafi, MD, MPH. “We were also surprised by how rapidly co-prescription rates fell after peaking around 2010. Such a rapid change suggests that a substantial portion of the initial opioid prescriptions were potentially avoidable.”
“Rates of accidental overdose are high and rising, and we are struggling as a country to address the problem,” said lead author Joseph Ladapo, MD, PhD. “As physicians, we have contributed to the problem, and one of the things we can do to address it is to reduce co-prescribing of benzodiazepines and opioids and think very hard about how to effectively treat patients’ pain while also reducing the risks the patient now faces from opioid therapy.” (Source: JAMA Psychiatry, April 12, 2018)