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One-third of office visits with benzodiazepine prescriptions involve overlapping opioids.
Benzodiazepines continued to be co-prescribed with opioids, despite risks that their concurrent use could lead to fatal overdose, a new CDC report showed.
From 2014 to 2016, benzodiazepines were prescribed at approximately 65.9 million office-based physician visits annually, according to Loredana Santo, MD, MPH, of the CDC’s National Center for Health Statistics in Hyattsville, Maryland, and co-authors.
About 23 million (35%) of those office visits also involved an overlapping opioid prescription, they reported in National Health Statistics Reports.
“The enormous growth in benzodiazepine prescribing has flown under most policymakers’ and clinicians’ radar,” noted Keith Humphreys, PhD, of Stanford University in California, who wasn’t involved with the study.
“These medications are implicated in a third of opioid overdoses, as well as being addictive in themselves,” Humphreys told MedPage Today. “The healthcare system should expand its ongoing safe-prescribing initiatives to cover benzodiazepines, too.”
Benzodiazepines can increase the respiratory depressant effects of opioids: a review of health claims data from 2001 to 2013 showed that among opioid users, concurrent use of benzodiazepines more than doubled the risk of an overdose-related emergency room or inpatient visit. In 2017, 11,537 overdose deaths involving benzodiazepines occurred; approximately 85% of those deaths involved an opioid.
Risks associated with co-prescribing benzodiazepines and opioids led to FDA boxed warnings in 2016 that highlighted the dangers of using these drugs together. In the CDC’s Guideline for Prescribing Opioids for Chronic Pain, opioid and benzodiazepine co-prescription is not recommended due to possible respiratory depression.
Annual rates of benzodiazepine prescribing increased with patient age: they were 13 visits per 100 adults ages 18 to 44, but jumped to 51 visits per 100 adults 65 and older. Benzodiazepine and opioid co-prescribing also increased with age, from 4 visits per 100 adults ages 18 to 44 to 16 visits per 100 adults 65 and over.
Benzodiazepine prescribing rates were highest for women 65 and older, at 62 annual visits per 100 women. Women 65 and older also had the highest rate of co-prescribing, at 19 visits per 100 women.
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