Emergency Department Visits and Overdose Deaths From Combined Use of Opioids and Benzodiazepines

      Introduction

      Opioid analgesics and benzodiazepines are the prescription drugs most commonly associated with drug overdose deaths. This study was conducted to assess trends in nonmedical use−related emergency department (ED) visits and drug overdose deaths that involved both opioid analgesics and benzodiazepines in the U.S. from 2004 to 2011.

      Methods

      Opioid analgesic and benzodiazepine nonmedical use−related ED visits from the Drug Abuse Warning Network and drug overdose deaths from the National Vital Statistics System were analyzed for 2004−2011 to determine trends and demographic-specific rates. Data were analyzed from March 2014 to June 2014.

      Results

      From 2004 to 2011, the rate of nonmedical use–related ED visits involving both opioid analgesics and benzodiazepines increased from 11.0 to 34.2 per 100,000 population (p-trend<0.0001). During the same period, drug overdose deaths involving both drugs increased from 0.6 to 1.7 per 100,000 (p-trend<0.0001). Statistically significant increases in ED visits occurred among males and females, non-Hispanic whites, non-Hispanic blacks, and Hispanics, and all age groups except 12- to 17-year-olds. For overdose deaths, statistically significant increases were seen in males and females, all three race/ethnicity groups, and all age groups except 12- to 17-year-olds. Benzodiazepine involvement in opioid analgesic overdose deaths increased each year, increasing from 18% of opioid analgesic overdose deaths in 2004 to 31% in 2011 (p-trend<0.0001).

      Conclusions

      ED visits and drug overdose deaths involving both opioid analgesics and benzodiazepines increased significantly between 2004 and 2011. Interventions to improve the appropriate prescribing and use of these medications are needed.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. CDC, National Center for Health Statistics. Vital statistics data available online. Last updated April 30, 2015. www.cdc.gov/nchs/data_access/Vitalstatsonline.htm. Accessed April 12, 2014.

        • Jones C.M.
        • Mack K.A.
        • Paulozzi L.J.
        Pharmaceutical overdose deaths, United States, 2010.
        JAMA. 2013; 309: 657-659https://doi.org/10.1001/jama.2013.272
      2. Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.

        • Peirce G.L.
        • Smith M.J.
        • Abate M.A.
        • et al.
        Doctor and pharmacy shopping for controlled substances.
        Med Care. 2012; 50: 494-500https://doi.org/10.1097/MLR.0b013e31824ebd81
        • Gomes T.
        • Mamdani M.M.
        • Dhalla I.A.
        • et al.
        Opioid dose and drug-related mortality in patients with nonmalignant pain.
        Arch Intern Med. 2011; 171: 686-691https://doi.org/10.1001/archinternmed.2011.117
        • Jann M.
        • Kennedy W.K.
        • Lopez G.
        Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics.
        J Pharm Pract. 2014; 27: 5-16https://doi.org/10.1177/0897190013515001
        • White J.M.
        • Irving R.J.
        Mechanisms of fatal opioid overdose.
        Addiction. 1999; 94: 961-972https://doi.org/10.1046/j.1360-0443.1999.9479612.x
        • Pattinson K.T.
        Opioids and the control of respiration.
        Br J Anaesth. 2008; 100: 747-758https://doi.org/10.1093/bja/aen094
        • Lee S.C.
        • Klein-Schwartz W.
        • Doyon S.
        • Welsh C.
        Comparison of toxicity associated with nonmedical use of benzodiazepines with buprenorphine or methadone.
        Drug Alcohol Depend. 2014; 138: 118-123https://doi.org/10.1016/j.drugalcdep.2014.02.014
        • Paulozzi L.J.
        • Zhang K.
        • Jones C.M.
        • et al.
        Risk of adverse health outcomes with increasing duration and regularity of opioid therapy.
        J Am Board Fam Med. 2014; 27: 329-338https://doi.org/10.3122/jabfm.2014.03.130290
        • Saunders K.W.
        • Von Korff M.
        • Campbell C.I.
        • et al.
        Concurrent use of alcohol and sedatives among persons prescribed chronic opioid therapy: prevalence and risk factors.
        J Pain. 2012; 13: 266-275https://doi.org/10.1016/j.jpain.2011.11.004
      3. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (December 13, 2012). The TEDS Report: Admissions Reporting Benzodiazepine and Narcotic Pain Reliever Abuse at Treatment Entry. Rockville, MD.

        • Dunn K.M.
        • Saunders K.W.
        • Rutter C.M.
        • et al.
        Opioid prescriptions for chronic pain and overdose: a cohort study.
        Ann Intern Med. 2010; 152: 85-92https://doi.org/10.7326/0003-4819-152-2-201001190-00006
        • Bohnert A.S.
        • Valenstein M.
        • Bair M.J.
        • et al.
        Association between opioid prescribing patterns and opioid overdose-related deaths.
        JAMA. 2011; 305: 1315-1321https://doi.org/10.1001/jama.2011.370
        • Hardo P.G.
        • Kennedy T.D.
        Night sedation and arthritic pain.
        J R Soc Med. 1991; 84: 73-75
        • Skurtveit S.
        • Furu K.
        • Bramness J.
        • Selmer R.
        • Tverdal A.
        Benzodiazepines predict use of opioids: a follow-up study of 17,074 men and women.
        Pain Med. 2010; 11: 805-814https://doi.org/10.1111/j.1526-4637.2010.00870.x
        • Compton W.M.
        • Volkow N.D.
        Abuse of prescription drugs and the risk of addiction.
        Drug Alcohol Depend. 2006; 83: S4-S7https://doi.org/10.1016/j.drugalcdep.2005.10.020
        • Jones J.D.
        • Mogali S.
        • Comer S.D.
        Polydrug abuse: a review of opioid and benzodiazepine combination use.
        Drug Alcohol Depend. 2012; 125: 8-18https://doi.org/10.1016/j.drugalcdep.2012.07.004
      4. U.S. DHHS. Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality. Drug Abuse Warning Network (DAWN), 2004−2011. ICPSR34565-v2. Ann Arbor, MI: Inter-University Consortium for Political and Social Research [distributor]. www.icpsr.umich.edu/icpsrweb/SAMHDA/. Accessed March 19, 2014.

      5. Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.

      6. U.S. Census Bureau. Population estimates. 2014. www.census.gov/popest/. Accessed April 20, 2014.

        • Murphy S.L.
        • Xu J.Q.
        • Kochanek K.D.
        Deaths: final data for 2010.
        Natl Vital Stat Rep. 2013; 61
        • Kim H.J.
        • Fay M.P.
        • Feuer E.J.
        • Midthune D.N.
        Permutation tests for joinpoint regression with applications to cancer rates.
        Stat Med. 2000; 19: 335-351https://doi.org/10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z
      7. National Cancer Institute. Joinpoint Regression Program: average annual percent change. 2014. http://surveillance.cancer.gov/joinpoint/. Accessed November 10, 2014.

        • Chen L.H.
        • Hedegaard H.
        • Warner M.
        Drug-poisoning deaths involving opioid analgesics: United States, 1999−2011. NCHS Data Brief no. 166.
        National Center for Health Statistics, Hyattsville, MD2014
        • Paulozzi L.J.
        • Jones C.M.
        • Mack K.A.
        • Rudd R.A.
        Vital signs: overdoses of prescription opioid pain relievers—United States, 1999−2008.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 1487-1492
        • Kao M.
        • Zheng P.
        • Hah J.
        • Mackey S.
        Trends in benzodiazepine prescription and co-prescription with opioid in primary care clinics in the United States, 2002 to 2009.
        J Pain. 2014; 15: S41https://doi.org/10.1016/j.jpain.2014.01.168
        • Gorevski E.
        • Bian B.
        • Kelton C.M.
        • Martin Boone J.E.
        • Guo J.J.
        Utilization, spending, and price trends for benzodiazepines in the US Medicaid program.
        Ann Pharmacother. 2012; 46: 503-512https://doi.org/10.1345/aph.1Q618
        • Paulozzi L.J.
        • Warner M.
        • Jones C.M.
        Defining controlled substances overdoses: some challenges.
        J Clin Toxicol. 2013; 3: 175
      8. National Institute on Drug Abuse. Prescription drugs: abuse and addiction. 2011. http://www.drugabuse.gov/publications/research-reports/prescription-drugs/director. Accessed January 29, 2015.