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The growing problem of co-treatment with opioids and benzodiazepines

BMJ 2017; 356 doi: (Published 14 March 2017) Cite this as: BMJ 2017;356:j1224
  1. Pinar Karaca-Mandic, associate professor1,
  2. Ellen Meara, professor2,
  3. Nancy E Morden, associate professor2
  1. 1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN 55455-0381, USA
  2. 2Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH 03755-1404, USA
  1. Correspondence to: P Karaca-Mandic

A powerful example of potentially dangerous low value care

Since 1999, the US has witnessed a fourfold increase in deaths from overdose involving prescription opioids,1 a fact widely known by US residents. That benzodiazepines are present in over 30% of overdoses involving prescription opioids is less well known.2

Using claims based data from 315 428 privately insured individuals in the US with at least one filled prescription for an opioid in 2001-13, Sun and colleagues (doi:10.1136/bmj.j760) examined the prevalence of a hazardous prescription combination.3 The risk of combining opioids and benzodiazepines has long been understood; both drug classes can be sedating, suppress respiratory efforts, impair thought, slow response time, and increase falls.2 Sun and colleagues found an alarming rise in this prescribing practice in their study population, from 9% in 2001 to 17% in 2013. They report a significantly increased risk of overdose among patients receiving both drug types concurrently, documenting one type of harm associated with this unsound and growing clinical practice.

The study emerges at a time when clinicians …

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