a Department of Medicine, Division of Hospital Medicine , Denver Health Medical Center , Denver , CO , USA.
b Department of Medicine, Division of General Internal Medicine , University of Colorado Denver , CO , USA.
Clin Toxicol (Phila). 2018 Nov;56(11):1107-1114. doi: 10.1080/15563650.2018.1457792. Epub 2018 Apr 3.
Prior works demonstrates an increased risk of death when opioid analgesics and benzodiazepines are used concomitantly to gain a high. Using poison center data, we described trends in abuse or misuse of benzodiazepines and opioid analgesics. We quantified mortality risk associated with abuse or misuse of benzodiazepines, opioid analgesics and the combination of opioid analgesics and benzodiazepines.
This was a retrospective chart review of data from the National Poison Data System which collects information from 55 poison centers located across the United States. We identified reported cases of "intentional abuse or misuse" of benzodiazepine and/or opioid analgesic exposures. Poisson regression was used to compare the number of cases from each year between 2001 and 2014 to the year 2000. Logistic regression was used to determine whether cases exposed to both benzodiazepines and opioids had greater odds of death relative to cases exposed to opioid analgesics alone.
From 2000 to 2014, there were 125,485 benzodiazepine exposures and 84,627 opioid exposures among "intentional abuse or misuse" cases. Of the benzodiazepine exposures, 17.3% (n = 21,660) also involved an opioid. In 2010, exposures involving both opioids and benzodiazepines were 4.26-fold (95% CI: 3.87-4.70; p < .001) higher than in 2000. The risk of death was 1.55 (95% CI: 1.01-2.37; p = .04) times greater among those who used both an opioid and a benzodiazepine compared to opioids alone. This association held after adjusting for gender and age.
Intentional abuse or misuse of benzodiazepines and opioids in combination increased significantly from 2000 to 2014. Benzodiazepine abuse or misuse far exceeded cases of opioid abuse or misuse. Death was greater with co-abuse or misuse of benzodiazepines and opioids. Population-level campaigns to inform the public about the risk of death with co-abuse or misuse of benzodiazepines and opioids are urgently needed to address this overdose epidemic.
先前的研究表明，阿片类镇痛药和苯二氮䓬类药物同时使用以获得快感会增加死亡风险。利用中毒中心的数据，我们描述了苯二氮䓬类药物和阿片类镇痛药滥用或误用的趋势。我们量化了与苯二氮䓬类药物、阿片类镇痛药和阿片类镇痛药与苯二氮䓬类药物联合滥用或误用相关的死亡风险。
这是一项对国家毒物数据系统（National Poison Data System）收集的来自美国 55 个中毒中心信息的回顾性图表研究。我们确定了报告的苯二氮䓬类药物和/或阿片类镇痛药暴露的“故意滥用或误用”案例。使用泊松回归比较了 2001 年至 2014 年每年的病例数与 2000 年的病例数。使用逻辑回归来确定同时暴露于苯二氮䓬类药物和阿片类药物的病例相对于仅暴露于阿片类镇痛药的病例，其死亡的可能性是否更大。
2000 年至 2014 年，在“故意滥用或误用”的病例中，有 125485 例苯二氮䓬类药物暴露和 84627 例阿片类药物暴露。在苯二氮䓬类药物暴露中，有 17.3%（n=21660）还涉及阿片类药物。2010 年，同时使用阿片类药物和苯二氮䓬类药物的暴露量是 2000 年的 4.26 倍（95%CI：3.87-4.70；p<0.001）。与单独使用阿片类药物相比，同时使用阿片类药物和苯二氮䓬类药物的死亡风险高出 1.55 倍（95%CI：1.01-2.37；p=0.04）。在调整性别和年龄后，这种关联仍然存在。
2000 年至 2014 年，苯二氮䓬类药物和阿片类药物联合故意滥用或误用的情况显著增加。苯二氮䓬类药物滥用或误用的情况远远超过阿片类药物滥用或误用的情况。同时滥用或误用苯二氮䓬类药物和阿片类药物会导致更高的死亡风险。迫切需要开展以人群为基础的宣传活动，让公众了解同时滥用或误用苯二氮䓬类药物和阿片类药物会导致死亡的风险，以应对这一阿片类药物滥用过量的流行。
