BACKGROUND: The 2016 CDC Guideline for Prescribing Opioids for Chronic Pain discusses the dangers associated with taking an opioid with benzodiazepines. Additionally, on August 31, 2016 the U.S. Food and Drug Administration (FDA) issued a strong warning about the serious risks associated with combined use of opioid analgesics and benzodiazepine. Risks include extreme sleepiness, respiratory depression, coma and death. With these strong warnings from the CDC and the FDA, North Carolina (NC) began assessing the number of residents with prescriptions for both an opioid analgesic and a benzodiazepine as well as the number of opioid analgesic poisoning deaths involving a benzodiazepine.
METHODS: Unintentional medication/drug poisoning deaths were identified from Vital Records death certificate data using ICD–10 underlying cause-of-death codes X40–X44. Opioid analgesic poisoning deaths are drug poisoning deaths with a multiple cause-of-death code of T40.2, T40.3, or T40.4. Opioid analgesic poisoning deaths that involve a benzodiazepine have an additional multiple cause-of-death code of T42.4. Data on overlapping prescriptions for both an opioid analgesic and a benzodiazepine were obtained from the NC Controlled Substances Reporting System (CSRS).
RESULTS: The rate of deaths from an opioid analgesic and a benzodiazepine has increased from 0.17 per 100,000 residents in 2000 to a rate of 2.67 per 100,000 residents in 2015. In 2000, 8.3% of opioid analgesic deaths also involved a benzodiazepine compared to 36.0% in 2015. In 2011 there were 14.2 overlapping opioid analgesic and benzodiazepine prescriptions written for every 100 NC residents compared to 16.8 in 2015. Analyses are ongoing at the county level; of particular interest to the authors is the correlation between number of overlapping prescriptions and overdose deaths involving both an opioid and a benzodiazepine in each of our 100 counties.
CONCLUSIONS: Rates of overdose involving both an opioid analgesic and a benzodiazepine have significantly increased in NC over the last 16 years, and rates of overlapping prescriptions have increased over the five years for which data was available. Our results indicate a need for increased knowledge of the dangers of taking an opioid analgesic in combination with a benzodiazepine; education efforts should target both prescribers and patients.