Hospitalizations for opioid‐related overdose and timing of concurrent opioid and benzodiazepine use: A nested case‐control study

Background Concurrent opioid and benzodiazepine (BZD) use is a prevalent high‐risk prescribing behavior that increases the risk of opioid overdose. However, there is limited evidence on the relationship between timing of concurrent use and risk of opioid overdose. Objective To evaluate the likelihoo...

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Bibliographic Details
Published in:Pharmacotherapy 2021-09, Vol.41 (9), p.722-732
Main Authors: Alobaidi, Ali, Pickard, A. Simon, Jarrett, Jennie B., Lee, Todd A.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - adverse effects
Benzodiazepines
Benzodiazepines - administration & dosage
Benzodiazepines - adverse effects
Case-Control Studies
concurrent use
Drug overdose
Drug Therapy, Combination - adverse effects
Female
Hospitalization
Humans
Male
Middle Aged
Narcotics
Opiate Overdose - epidemiology
Opiate Overdose - therapy
opioid epidemic
opioid overdose
Opioids
Overdose
Regression analysis
Retrospective Studies
Sex ratio
Time Factors
Young Adult
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Summary:Background Concurrent opioid and benzodiazepine (BZD) use is a prevalent high‐risk prescribing behavior that increases the risk of opioid overdose. However, there is limited evidence on the relationship between timing of concurrent use and risk of opioid overdose. Objective To evaluate the likelihood of opioid‐related overdose across levels of duration, recency, and daily dose of concurrent use. Design A nested case‐control study was conducted using Truven MarketScan claims data (2009–2018). Participants Commercially insured adults (age 18–64 years old) with a new opioid dispensing in 2010–2018. Main Measures Cases of opioid‐related overdose were identified based on hospitalization diagnosis codes. Controls were matched to cases in a 10:1 ratio by age, sex, opioid start date, and cancer history. Concurrent use was classified based on duration, timing, and daily dose of overlapping opioids and BZDs during 90 days before the event. Conditional logistic regression models were used to evaluate the relationship between concurrent use and opioid‐related overdose. Key Results Among 11,137,866 dispensed a new opioid, a total of 3388 patients experienced opioid‐related overdose and were matched to 33,893 controls. Cases and controls were 34 years old on average and 54% female. Patients with concurrent use were significantly more likely to have opioid‐related overdose compared to patients receiving opioids, BZDs, or neither (OR 9.28; 95% CI 7.87, 10.93). Longer concurrent use of 1–7, 8–30, and 31–90 days was associated with 4.6, 12.1, and 26.7‐fold higher likelihood of opioid‐related overdose (p 
ISSN:0277-0008
1875-9114
DOI:10.1002/phar.2608