The Risk Factors and Mortality Among Patients With Different Combination Patterns of Opioids and Benzodiazepines: A...

Area of Science:

• Pharmacology
• Public Health
• Epidemiology

Background:

• Concurrent opioid and benzodiazepine (BZD) use is associated with increased risks of respiratory depression and mortality.
• Understanding the specific mortality risks tied to different co-prescription patterns is crucial for patient safety.

Purpose of the Study:

• To evaluate the association between various patterns of benzodiazepine (BZD) use and all-cause mortality among opioid users.
• To quantify the mortality risks associated with continuous, new, and past BZD use in conjunction with opioid therapy.

Main Methods:

• Retrospective cohort study utilizing data from a private hospital system (2008-2018).
• Analysis of 418,549 opioid users categorized into four groups based on BZD use (opioids only, past use, continuous use, new initiation).
• Cox proportional hazards regression model used to calculate adjusted hazard ratios (aHRs) for 1-year all-cause mortality, controlling for medical history and Charlson Comorbidity Index (CCI).

Main Results:

• Compared to opioid-only users, significantly higher 1-year mortality risks were observed for continuous BZD users (aHR=1.78), new BZD initiators (aHR=1.56), and past BZD users (aHR=1.29).
• Older age, cancer diagnosis, and a higher comorbidity burden were also associated with increased mortality.
• All evaluated patterns of benzodiazepine (BZD) use in combination with opioids demonstrated elevated mortality risks.

Conclusions:

• The concurrent use of opioids and benzodiazepines (BZD) is associated with significantly increased mortality across different usage patterns.
• Prescribing practices for opioids and BZDs require careful consideration, particularly for elderly patients and those with multiple comorbidities.
• These findings underscore the importance of risk mitigation strategies when co-prescribing opioids and benzodiazepines (BZD).