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Reexamined: The Opioid and Benzo Combo

Opioid addictions is a public health epidemic and not going away anytime soon. The use of combined opioid and benzodiazepines (BZD) is affecting more lives than ever for people of all ages. Opioids are used to relieve pain while BZDs are commonly prescribed to sedate, particularly for anxiety or insomnia. Combined, these drugs are potentially deadly. Over 30 percent of individuals who overdose use this relief-sedate combo.

According to a study led by researchers at the University of California, San Francisco and Stanford University, 9 percent of opioid users used a BZD in 2001. Twelve years later (2013), the BZD use increased to 17 percent, an 80 percent relative increase. Among the 315 428 study participants, individuals who used an opioid-benzo combination were more than twice as likely to visit an emergency department or be admitted to the hospital..

Last year, the Centers for Disease Control and Prevention (CDC) issued “black box” warnings on opioid and benzo labels to alert clinicians of the combined danger. If possible, clinicians are to avoid prescribing these drugs together.

CHPSO Event Reports on Opioids and Benzodiazepines

In 2016 alone, over 150 member hospitals submitted 62,000 medication-specific events to the CHPSO database.

Events by Gender

In a sample of events, 40 percent involved females, and 34 percent involved males. The remaining were either not mentioned or mapped to the CHPSO database.

Events by Age

Also in that sample, of those events where age was indicated, 55 percent involved adults aged 18–64 and 42 percent were in patients 65 and older. Only 3 percent were in adolescents or children.

Events by Location

Approximately 37 percent of the sampled opioid-BZD event reports occurred in the inpatient general care area. Almost 22 percent occurred in ICUs, 18 percent in the operating room or procedure area, 14 percent in pharmacy, and one percent in labor and delivery. Nearly 5 percent of events were not mapped in the CHPSO database to a location.

As of September 2017, over 413,000 medication events exist in the CHPSO database. Over 66,000 events mentioned opioid agonists.

Drugs Mentioned Number of Mentions
Opioid Agonist 66,014
Insulin 30,591
Benzodiazepine 22,080
Acetaminophen 21,006
Penicillin-class Antibacterial 19,587
Heparin (incl fractionated) 14,261
Corticosteroid 12,427
Histamine-1 Antagonist 12,288
Vancomycin 12,135
Cephalosporin 10,395

Tools and Resources

The following tools and resources are available for free and attached to this article (right column of this web page):

  • The American Society of Health System Pharmacists released guidelines on diversion. ASHP guideline on diversion
  • Perspective published in New England Journal of Medicine regarding treating patients with history of abuse
  • Reducing Adverse Drug Events Related to Opioids, implementation guide by Society of Hospital Medicine
  • Joint Commission prepublication of Standards Revisions related to Pain Assessment and Management.

To assess pain in patients, particularly in children, the FLACC (Face, Legs, Activity, Cry, Consolability) Scale, developed by Massachusetts General Hospital is suggested tool. It is attached and also available online by clicking here

To assess pain in adults, the Adult Non-verbal Pain Scale, developed from FLACC, is recommended. It is attached and available here from Critical Care Nurse Journal.

Other Attached Resources

  • ASHP guideline on diversion
  • Perspective published in New England Journal of Medicine regarding treating patients with history of abuse
  • Reducing Adverse Drug Events Related to Opioids, implementation guide by Society of Hospital Medicine
  • Joint Commission prepublication of Standards Revisions related to Pain Assessment and Management.

References

  1. 2016 CHPSO Annual Report: http://www.chpso.org/pod/2016-chpso-annual-report-0
  2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016;65. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
  3. 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. 2017;356:j760. http://www.bmj.com/content/356/bmj.j760