ArticleDrug and alcohol dependence2025
Dose trajectories associated with non-fatal overdose among patients co-prescribed opioids and benzodiazepines: Retrospective cohort study.
Article in Drug and alcohol dependence, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo assess opioid and benzodiazepine prescribing trajectories associated with overdose.
methodsRetrospective cohort study of Optum Labs Data Warehouse data which includes de-identified medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees. The database contains longitudinal health information on patients, representing a mixture of ages and geographical regions across the United States. The cohort comprised adults prescribed opioids for 80 % of a 180-day baseline period ending with at least 10 days of overlapping opioid and benzodiazepine coverage from July 1, 2016 to December 31, 2021 (N = 182,477). The primary outcome was an opioid or benzodiazepine overdose resulting in emergency or hospital services through December 31, 2022. Time-varying covariates included: 1) short-term trajectory based on recent change in mean daily morphine milligram equivalents (MME) or diazepam milligram equivalents (DME); and 2) long-term trajectory based on 180-day trend.
resultsFor both opioids and benzodiazepines, overdose risk was increased with both decreasing and increasing short-term and long-term trajectories relative to stable doses. Compared to stable dosing, short-term decreases in MME and DME were associated with similar magnitudes of increased overdose risk [adjusted hazard ratios (aHRs) 1.41 (95 % CI: 1.31-1.52) vs. 1.23 (95 % CI: 1.12-1.35), respectively), as were long-term decreases in MME and DME [aHRs 1.29 (95 % CI: 1.21-1.38) vs. 1.36 (95 % CI: 1.24-1.48), respectively).
conclusionsAmong co-prescribed patients, decreasing short- and long-term trajectories of either opioids or benzodiazepines were associated with a similar increase in non-fatal overdose risk.
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