Opioids combined with this drug could be especially dangerous

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In a new study, researchers found that taking both short-acting benzodiazepines (a sedative drug) and opioids may put patients at an especially high risk of dying prematurely.

The research was conducted by a team at Johns Hopkins Medical Institutions and elsewhere.

Increasing the use of opioids in recent years has led to rising numbers of deaths and hospitalizations due to overdoses.

In light of this opioid epidemic, it is important to understand whether other medications interact with opioids to elevate risks for patients.

In the study, the team looked to see if such an interaction exists for benzodiazepines (also considered tranquilizers or sedatives), which are some of the most commonly prescribed medications in the United States.

The study included 69,368 US adults with kidney failure who started hemodialysis in 2013 or 2014.

Many patients with kidney failure have physical and psychiatric conditions that are treated with benzodiazepines, and they are also 3-times more likely to be prescribed opioids than the general population.

During a median follow-up of 16 months, 15,175 patients (30%) died. Medicare claims data revealed the following:

Within 1 year of hemodialysis initiation, 10,854 patients (16%) were dispensed a short-acting benzodiazepine and 3,262 patients (5%) were dispensed a long-acting benzodiazepine.

Among those who have dispensed a benzodiazepine, co-dispensing of opioids and short-acting benzodiazepines occurred in 3,819 (26%) patients and co-dispensing of opioids and long-acting benzodiazepines occurred in 1,238 (8%) patients.

Patients with an opioid prescription were 1.66-fold more likely to be subsequently dispensed a short-acting benzodiazepine and 1.11-fold more likely to be subsequently dispensed a long-acting benzodiazepine.

Patients dispensed a short-acting benzodiazepine were at a 1.45-fold higher risk of dying during follow-up compared with those without a short-acting benzodiazepine; among those with opioid co-dispensing, the risk was 1.90-fold higher.

In contrast, long-acting benzodiazepine dispensing was associated with a 16% lower risk of dying compared with no dispensing of long-acting benzodiazepine; there was no differential risk by opioid dispensing.

The team says the potential risks associated with short-acting benzodiazepines should always be weighed against their therapeutic benefit and patients undergoing hemodialysis who are currently undergoing treatment with short-acting benzodiazepines should consider other treatments when clinically appropriate.

Furthermore, providers caring for patients undergoing hemodialysis should be given the tools needed to implement a collaborative, team-based approach for deprescribing of short-acting benzodiazepines, particularly for patients who are likely to use opioids.

The lead author of the study is Mara McAdams-DeMarco, Ph.D.

The study is published in CJASN.

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