Association between concurrent use of prescription #opioids and #benzodiazepines and #overdose: retrospective analysis
http://www.bmj.com/content/356/bmj.j760
Compared with opioid users who did not use benzodiazepines, concurrent use of both drugs was associated with an increased risk of an emergency room visit or inpatient admission for opioid overdose (adjusted odds ratio 2.14, 95% confidence interval 2.05 to 2.24; P<0.001) among all opioid users. The adjusted odds ratio for an emergency room visit or inpatient admission for opioid overdose was 1.42 (1.33 to 1.51; P<0.001) for intermittent opioid users and 1.81 (1.67 to 1.96; P<0.001) chronic opioid users.
http://www.bmj.com/content/356/bmj.j760
Compared with opioid users who did not use benzodiazepines, concurrent use of both drugs was associated with an increased risk of an emergency room visit or inpatient admission for opioid overdose (adjusted odds ratio 2.14, 95% confidence interval 2.05 to 2.24; P<0.001) among all opioid users. The adjusted odds ratio for an emergency room visit or inpatient admission for opioid overdose was 1.42 (1.33 to 1.51; P<0.001) for intermittent opioid users and 1.81 (1.67 to 1.96; P<0.001) chronic opioid users.
The BMJ
Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis
Objectives To identify trends in concurrent use of a benzodiazepine and an opioid and to identify the impact of these trends on admissions to hospital and emergency room visits for opioid overdose.
Design Retrospective analysis of claims data, 2001-13.…
Design Retrospective analysis of claims data, 2001-13.…
#Benzodiazepines and risk of all cause #mortality in adults: cohort study
http://www.bmj.com/content/358/bmj.j2941
To evaluate the risk of all cause mortality associated with initiating compared with not initiating benzodiazepines in adults, and to address potential treatment barriers and confounding related to the use of a non-active comparator group.
Conclusions This large population based cohort study suggests either no increase or at most a minor increase in risk of all cause mortality associated with benzodiazepine initiation. If a detrimental effect exists, it is likely to be much smaller than previously stated and to have uncertain clinical relevance. Residual confounding likely explains at least part of the small increase in mortality risk observed in selected analyses.
http://www.bmj.com/content/358/bmj.j2941
To evaluate the risk of all cause mortality associated with initiating compared with not initiating benzodiazepines in adults, and to address potential treatment barriers and confounding related to the use of a non-active comparator group.
Conclusions This large population based cohort study suggests either no increase or at most a minor increase in risk of all cause mortality associated with benzodiazepine initiation. If a detrimental effect exists, it is likely to be much smaller than previously stated and to have uncertain clinical relevance. Residual confounding likely explains at least part of the small increase in mortality risk observed in selected analyses.
The BMJ
Benzodiazepines and risk of all cause mortality in adults: cohort study
Objectives To evaluate the risk of all cause mortality associated with initiating compared with not initiating benzodiazepines in adults, and to address potential treatment barriers and confounding related to the use of a non-active comparator group.
Design…
Design…
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#Benzodiazepines , Health Care Utilization, and #Suicidal Behavior in Veterans With Posttraumatic Stress Disorder
https://www.psychiatrist.com/JCP/article/Pages/2018/v79/17m12038.aspx
.. Veterans with PTSD who received benzodiazepines had significantly more hospitalizations (incident rate ratio [IRR] = 1.27; 95% CI, 1.10–1.47) and emergency department (IRR = 1.16; 95% CI, 1.13–1.20), general outpatient (IRR = 1.19; 95% CI, 1.16–1.21), outpatient mental health (IRR = 1.49; 95% CI, 1.41–1.57), and total mental health (IRR = 1.37; 95% CI, 1.34–1.40) visits. Benzodiazepine users had a significantly greater risk of death due to suicide (hazard ratio [HR] = 2.74; 95% CI, 2.40–3.13) and were significantly more likely to have medically documented suicide attempts (HR = 1.85; 95% CI, 1.65–2.08) and suicidal ideation (HR = 1.57; 95% CI, 1.48–1.67).
Conclusions: Benzodiazepine users had higher rates of health care utilization and were more likely to attempt and complete suicide than patients without benzodiazepine exposure. This study strengthens the empirical evidence against the use of benzodiazepines in veterans with PTSD. Prescribers should weigh the benefits and risks—especially the almost 3-fold increase in suicide risk—when prescribing benzodiazepines in these patients
#Benzodiazepines , Health Care Utilization, and #Suicidal Behavior in Veterans With Posttraumatic Stress Disorder
https://www.psychiatrist.com/JCP/article/Pages/2018/v79/17m12038.aspx
.. Veterans with PTSD who received benzodiazepines had significantly more hospitalizations (incident rate ratio [IRR] = 1.27; 95% CI, 1.10–1.47) and emergency department (IRR = 1.16; 95% CI, 1.13–1.20), general outpatient (IRR = 1.19; 95% CI, 1.16–1.21), outpatient mental health (IRR = 1.49; 95% CI, 1.41–1.57), and total mental health (IRR = 1.37; 95% CI, 1.34–1.40) visits. Benzodiazepine users had a significantly greater risk of death due to suicide (hazard ratio [HR] = 2.74; 95% CI, 2.40–3.13) and were significantly more likely to have medically documented suicide attempts (HR = 1.85; 95% CI, 1.65–2.08) and suicidal ideation (HR = 1.57; 95% CI, 1.48–1.67).
Conclusions: Benzodiazepine users had higher rates of health care utilization and were more likely to attempt and complete suicide than patients without benzodiazepine exposure. This study strengthens the empirical evidence against the use of benzodiazepines in veterans with PTSD. Prescribers should weigh the benefits and risks—especially the almost 3-fold increase in suicide risk—when prescribing benzodiazepines in these patients
Psychiatrist
J Clin Psychiatry/Benzodiazepines, Health Care Utilization, and Suicidal Behavior in Veterans With Posttraumatic Stress Disorder
Although benzodiazepines can provide short-term relief for anxiety, their potential to worsen depression and suicidal thoughts potentially recommends against their use in patients with PTSD. Read this article to learn how use of these agents relates to health…
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#Benzodiazepines or related drugs and risk of #pneumonia: A systematic review and meta‐analysis
https://onlinelibrary.wiley.com/doi/full/10.1002/gps.5048
Benzodiazepines and benzodiazepine‐related drugs (BZRDs) are used to treat various psychiatric diseases. However, there are concerns that BZRDs increase the risk of pneumonia.
After pooling the estimates, the odds for developing pneumonia were 1.25‐fold higher (odd ratio, OR = 1.25; 95% confidence interval (CI), 1.09‐1.44) in BZRD users compared with individuals who had not taken BZRD. On the basis of exposure window, we found an increased risk of pneumonia among current (OR = 1.4; 95%CI, 1.22‐1.6) and recent (OR = 1.38; 95%CI, 1.06‐1.8) users, but not with the past users (OR = 1.11; 95%CI, 0.96‐1.27).
Conclusion
Current or recent exposure to BZRD is associated with an increased pneumonia risk. Clinicians need to weight the benefit‐risk balance of BZRD use, especially those with other risk factors for pneumonia.
#Benzodiazepines or related drugs and risk of #pneumonia: A systematic review and meta‐analysis
https://onlinelibrary.wiley.com/doi/full/10.1002/gps.5048
Benzodiazepines and benzodiazepine‐related drugs (BZRDs) are used to treat various psychiatric diseases. However, there are concerns that BZRDs increase the risk of pneumonia.
After pooling the estimates, the odds for developing pneumonia were 1.25‐fold higher (odd ratio, OR = 1.25; 95% confidence interval (CI), 1.09‐1.44) in BZRD users compared with individuals who had not taken BZRD. On the basis of exposure window, we found an increased risk of pneumonia among current (OR = 1.4; 95%CI, 1.22‐1.6) and recent (OR = 1.38; 95%CI, 1.06‐1.8) users, but not with the past users (OR = 1.11; 95%CI, 0.96‐1.27).
Conclusion
Current or recent exposure to BZRD is associated with an increased pneumonia risk. Clinicians need to weight the benefit‐risk balance of BZRD use, especially those with other risk factors for pneumonia.
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Association Between Incident Exposure to #Benzodiazepines in Early Pregnancy and Risk of Spontaneous #Abortion
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2733517
Among pregnancies ending with SA, 375 (1.4%) were among women exposed to benzodiazepines in early pregnancy compared with 788 (0.6%) of the 134 305 matched control pregnancies (crude OR, 2.39; 95% CI, 2.10-2.73). Adjusting for potential confounders, including maternal mood and anxiety disorders before pregnancy, and compared with nonuse, benzodiazepine exposure in early pregnancy was associated with an increased risk of SA (adjusted OR, 1.85; 95% CI, 1.61-2.12). The risk was similar among pregnancies exposed to short-acting (284 exposed cases; adjusted OR, 1.81; 95% CI, 1.55-2.12) and long-acting (98 exposed cases; adjusted OR, 1.73; 95% CI, 1.31-2.28) benzodiazepines during early pregnancy. All benzodiazepine agents were independently associated with an increased risk of SA (range of adjusted ORs, 1.13-3.43).
Conclusions and Relevance An increased risk of SA was observed among early pregnancies with incident exposure to short and long-acting benzodiazepines and all specific benzodiazepine agents during early pregnancy. Insomnia, anxiety, and mood disorders are prevalent during pregnancy; clinicians should carefully evaluate the risk/benefit ratio of prescribing benzodiazepines in early pregnancy since alternative nonpharmacologic treatments exist.
Association Between Incident Exposure to #Benzodiazepines in Early Pregnancy and Risk of Spontaneous #Abortion
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2733517
Among pregnancies ending with SA, 375 (1.4%) were among women exposed to benzodiazepines in early pregnancy compared with 788 (0.6%) of the 134 305 matched control pregnancies (crude OR, 2.39; 95% CI, 2.10-2.73). Adjusting for potential confounders, including maternal mood and anxiety disorders before pregnancy, and compared with nonuse, benzodiazepine exposure in early pregnancy was associated with an increased risk of SA (adjusted OR, 1.85; 95% CI, 1.61-2.12). The risk was similar among pregnancies exposed to short-acting (284 exposed cases; adjusted OR, 1.81; 95% CI, 1.55-2.12) and long-acting (98 exposed cases; adjusted OR, 1.73; 95% CI, 1.31-2.28) benzodiazepines during early pregnancy. All benzodiazepine agents were independently associated with an increased risk of SA (range of adjusted ORs, 1.13-3.43).
Conclusions and Relevance An increased risk of SA was observed among early pregnancies with incident exposure to short and long-acting benzodiazepines and all specific benzodiazepine agents during early pregnancy. Insomnia, anxiety, and mood disorders are prevalent during pregnancy; clinicians should carefully evaluate the risk/benefit ratio of prescribing benzodiazepines in early pregnancy since alternative nonpharmacologic treatments exist.