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The association between benzodiazepine co-prescription, opioid agonist treatment and mortality: a systematic review

  • 0The Norwegian Institute of Public Health, Postboks 222 Skøyen, Oslo, 0213, Norway. chhe@fhi.no.
Bmc Psychiatry +

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October 29, 2024

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October 29, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Prescribed benzodiazepines during opioid agonist treatment (OAT) are likely linked to increased all-cause mortality. This association, particularly for non-drug-induced deaths, suggests caution when co-prescribing these medications.

Area Of Science

  • Addiction Medicine
  • Pharmacology
  • Public Health

Background

  • Opioid agonist treatment (OAT) is the standard for opioid dependence, improving retention and reducing harm.
  • Benzodiazepine co-dependence is prevalent among OAT patients, correlating with elevated mortality risks.
  • Prescribing benzodiazepines aims to mitigate harms from illicit use, but safety concerns persist.

Purpose Of The Study

  • To systematically review the association between benzodiazepine co-prescription and mortality in patients undergoing OAT.
  • To synthesize evidence from observational studies to inform clinical practice and harm reduction strategies.

Main Methods

  • Conducted a comprehensive literature search across multiple databases (MEDLINE, Embase, etc.) up to February 2024.
  • Included six observational studies (N=84,452) comparing mortality in OAT patients with and without benzodiazepine co-prescription.
  • Assessed risk of bias using ROBINS-I and certainty of evidence with GRADE; meta-analyses were performed where feasible.

Main Results

  • Moderate-certainty evidence indicates benzodiazepine prescription is associated with higher all-cause mortality on OAT (HR 1.83).
  • Benzodiazepine use was linked to increased non-drug-induced mortality during OAT (HR 1.73) and over the entire observation period (HR 2.02).
  • Low to very low-certainty evidence suggests potential associations with drug-induced mortality and all-cause mortality off OAT.

Conclusions

  • A probable association exists between prescribed benzodiazepines and increased all-cause and non-drug-induced mortality in OAT patients.
  • The link to drug-induced mortality and all-cause mortality off OAT is uncertain due to methodological limitations and confounding factors.
  • Findings suggest careful consideration of benzodiazepine co-prescription in OAT management due to potential mortality risks.

Keywords:

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