Deprescribing Strategies for Opioids and Benzodiazepines with Emphasis on Concurrent Use: A Scoping Review

Area of Science:

• Pharmacology
• Public Health
• Clinical Medicine

Background:

• Concurrent opioid and benzodiazepine (OPI-BZD) use carries significant risks, prompting FDA black-box warnings.
• Despite warnings, effective strategies for deprescribing OPI-BZD medications are lacking.
• Existing research primarily focuses on deprescribing opioids or benzodiazepines individually, not concurrently.

Purpose of the Study:

• To conduct a scoping review of available deprescribing strategies for opioid and/or benzodiazepine use.
• To identify and analyze research studies and guidelines on OPI-BZD deprescribing.
• To highlight gaps in current knowledge and guide future research.

Main Methods:

• Searched major databases (PubMed, EMBASE, Web of Science, Scopus, Cochrane Library) from 01/1995 to 08/2020.
• Included gray literature in the search.
• Analyzed identified original research studies and clinical guidelines.

Main Results:

• Identified 39 studies on opioid/benzodiazepine deprescribing and 26 guidelines; only 3 studies addressed concurrent OPI-BZD deprescribing.
• Concurrent OPI-BZD deprescribing interventions showed variable success rates (21-100%).
• Opioid deprescribing rates varied from 10-25% over weeks; benzodiazepine deprescribing involved phased reductions over weeks to months.

Conclusions:

• There is a critical need for more research to develop evidence-based guidelines for concurrent opioid and benzodiazepine deprescription.
• Current guidelines offer limited direction on the sequence for deprescribing OPI-BZD.
• Further studies are essential to establish safe and effective OPI-BZD deprescribing protocols.