MedicalResearch.com Interview with:
Dr. Nicholas Vozoris, MHSc, MD, FRCPC
Division of Respirology, Department of Medicine
St. Michael’s Hospital, 30 Bond Street
Toronto, Ontario, Canada
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: While there has been a lot of attention and research devoted to understanding trends in opioid use in North America, there has been relatively less attention paid to a more concerning drug use pattern, combination of benzodiazepines and opioids. Co-use of benzodiazepines and opioids is associated with a many more-fold risk of hospitalization and death than opioid use alone. Another concerning drug use pattern that has received little attention is combinations of benzodiazepines and Z-drugs. Z-drugs act similarly as benzodiazepine drugs, and when one is receiving both drug types, one is exposing oneself to excessive benzodiazepine receipt.
The purpose of my study was to characterize the trends in benzodiazepine and opioid co-use, and benzodiazepine and Z-drug co-use, in the United States over the past two decades, and to identify risk factors for receipt of these suboptimal drug use patterns.
The main findings were that there has been a dramatic rise in both benzodiazepine and opioid co-use, and benzodiazepine and Z-drug co-use, in the United States between 1999 and 2014. Benzodiazepine and opioid co-use increased by about 250% and benzodiazepine and Z-drug use increased by about 850%. Individuals with mental health disorders was one group at increased risk for getting a combination of benzodiazepines and opioids and morbidly obese individuals were at risk for being prescribed both a benzodiazepine and a Z-drug.
MedicalResearch.com: What should readers take away from your report?
Response: I hope readers of my study come away with a greater awareness of the potential concerns and problems that can arise with combining benzodiazepines and opioids, and benzodiazepines and Z-drugs. I hope prescribers become more reflective of their prescribing practices relating to such drugs as benzodiazepines, Z-drugs and opioids, and prescribe these agents with more judiciousness. In particular, I think there is a lot on confusion and lack of knowledge around the Z-drugs, that is, what drug group do they belong to and how do they act. Even though they go by the name Z-drugs, they act in the same way as benzodiazepines do, and so in effect, they can be considered as benzodiazepine-equivalents.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Although this can be challenging to get at, understanding the ‘why’ behind these rising concerning drug use patterns is important. Why are doctors prescribing, and why are patients receiving, in increasing numbers these concerning drug combinations? Having this knowledge would help us potentially reverse the trends of rising benzodiazepine and opioid co-use, and benzodiazepine and Z-drug co-use, and also potentially help prevent future ‘drug crises’. In September 2017, the US Food & Drug Administration issued that a safety warning be printed on all opioid and benzodiazepine drug labels, warning about the dangerous of combination use. In would be interesting to know if the frequency of combined benzodiazepines and opioids decreased as a result. Unfortunately, my study included only data up to 2014, so it was unable to ascertain an answer to this question.
Nicholas T Vozoris; Benzodiazepineand Opioid Co-Usage in the United States Population, 1999–2014: An Exploratory Analysis, Sleep, , zsy264, https://doi.org/10.1093/sleep/zsy264
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