Benzodiazepines and Opioids Don’t Mix

New Article on Risk of Combining Opioids and Benzodiazepines

A new study reviewed the risk of all-cause mortality and overdose death in patients with PTSD using opioids and benzodiazepines.  This study looked at 14,476 Veterans database between Oct 1, 2009 and Sep 30, 2011 diagnosed with post-traumatic stress disorder (PTSD).

Key Findings

Concurrent users of benzodiazepines and opioids had a:

1. Higher rate of all-cause mortality  (116 deaths) than:

  • Benzodiazepines only (75 deaths; adjusted hazard ratio = 1.52; 95% CI, 1.14–2.03)
  • Opioids only (67 deaths; 1.76; 95% CI, 1.32–2.35)
  • Non-users (60 deaths; 1.85; 95% CI, 1.30–2.64)

2. Higher rate of overdose deaths than:

  • Benzodiazepines only (adjusted subhazard ratio = 2.59; 95% CI, 1.00–6.66)
  • Opioids only (2.58; 95% CI, 1.09–6.11)
  • Non-user (9.16; 95% CI, 2.27–37.02)

Bottom-Line for Practice

  • People with PTSD using both opioids and benzodiazepines had almost double the risk of all-cause mortality and over 9 times the risk of overdose death versus non-users
  • The rate of all-cause mortality and overdose deaths were higher with the combination than with patients who used only a benzodiazepine or opioid
  • This matches the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain recommendation of not using both benzodiazepines and opioids at the same time
  • We should let patients know that the combination increases their risk of serious harm and look for strategies to reduce harm:
    • Taper off benzodiazepines
    • Provide naloxone
    • Educate on patients on the overall risk