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Stanford Medicine Scope - March 14th, 2017 - by Beth Duff-Brown

For those of us following the confounding opioid epidemic, there’s more bad news. Stanford researchers have determined that taking strong prescription painkillers together with sleeping pills is associated with greater risk of overdose.

Ninety-one Americans die every day from an opioid overdose — a number that has quadrupled since 1999, according to the Center for Disease Control and Prevention.

A study released today in The BMJ shows that nearly 30 percent of those fatal opioid overdoses in the United States also involve benzodiazepines, which are widely used to treat anxiety and sleep problems.

It seems like a no-brainer that you shouldn’t combine the two. But doctors appear to be increasingly prescribing both — at the same time. Using a large sample of privately insured patients from 2001 to 2013, the researchers found that concurrent sleeping pill and opioid prescribing increased by 80 percent over that time period.

Stanford anesthesiologist Eric Sun, MD, PhD, is lead author of the study, and Sean Mackey, MD, PhD, chief of pain medicine, is senior author.

“It’s probably pretty well known that prescribing an opioid and a benzodiazepine is a potentially risky combination,” Sun said. “One of the goals of our paper was to see the extent to which this still occurred despite this knowledge. Overall, we found that it happens, but more importantly, it’s been increasing over time.”

The researchers set out 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.

Their study involved over 300,000 privately insured people aged 18 to 64 who were prescribed an opioid and a benzodiazepine. They found that 9 percent of opioid users also used a benzodiazepine in 2001, increasing to 17 percent in 2013, or an 80 percent relative increase.

“This increase was driven mainly by increases among intermittent, as opposed to chronic, opioid users,” the authors wrote.

Compared with opioid users who did not use benzodiazepines, concurrent use of both drugs was associated with a substantially higher risk of an emergency room visit or inpatient admission for opioid overdose.

This is an observational study, however, so no firm conclusions can be drawn about cause and effect. But if this association is found to be causal, elimination of the concurrent use of benzodiazepines and opioids “could reduce the population risk of an emergency room visit or inpatient admission for opioid overdose by 15 percent,” the authors said.

They wrote that policymakers and health care systems “should also focus on benzodiazepine prescribing behaviors, as these behaviors can play an important role in mitigating the risks of opioid prescriptions.”

Education programs should be implemented at hospitals and clinics, they wrote, suggesting that the training programs emulate the Veterans Health Administration’s initiative to reduce the use of opioids for chronic pain.

Originally published at Stanford Medicine Scope Blog