The growing problem of co-treatment with opioids and benzodiazepinesBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1224 (Published 14 March 2017) Cite this as: BMJ 2017;356:j1224
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The editorial by Karaca-Mandic is an interesting read, measuring the opioid-benzodiazepine co-prescription as a potentially dangerous low-value care. We appreciate that the author could speak out the need of practice change with regards to this unsafe combination.
Regarding the improvement of the quality of care, we would like to echo the same as also commented by Sun et al. (1). Just like opioids, there should be multilevel target approaches in combating this near epidemic unsafe use of drug combination. In other words adding Benzodiazepines to all campaigns against opioids may be more effective. These can be ranging from patient education, physician awareness, developing new clinic or hospital strategies and policy changes by the government (2).
Using non-opioids or non-benzodiazepines as an initial or alternative therapy, discussing goals of treatment with patients, cessation of the dosage or combination of medications as appropriate may help in decreasing morbidity and mortality (3. 4)
1. Sun EC, Dixit A, Humphreys K, Darnall BD, Baker LC, Mackey S. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ (Clinical research ed). 2017;356:j760.
3. Tvete IF, Bjorner T, Aursnes IA, Skomedal T. A 3-year survey quantifying the risk of dose escalation of benzodiazepines and congeners to identify risk factors to aid doctors to more rationale prescribing. BMJ open. 2013;3(10):e003296.
4. Alford DP, Cohen ML, Reynolds EE. How Would You Manage Opioid Use in These Three Patients?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Annals of internal medicine. 2017;166(7):506-13.
Competing interests: No competing interests