VA Puget Sound Health Care System-Seattle Division (S116ATC), 1660 S. Columbian Way, Seattle, WA 98108.
Health Services Research & Development Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA.
J Clin Psychiatry. 2019 Jul 9;80(4):18m12689. doi: 10.4088/JCP.18m12689.
Opioids and benzodiazepines are commonly coprescribed medications. The mortality risk associated with their concurrent use is unknown.
To estimate the all-cause mortality risk for patients newly prescribed opioids and benzodiazepines concurrently relative to patients prescribed benzodiazepines only, opioids only, or neither medication.
This propensity score-matched, retrospective, cohort study included 17,476 patients receiving Veterans Affairs (VA) health care between October 1, 2009, and September 30, 2011, and diagnosed with posttraumatic stress disorder identified using ICD-9-CM code 309.81. One-year total and cause-specific mortality was assessed by hazard ratios and subhazard ratios, adjusted for propensity score, age, baseline psychiatric and medical comorbidity, and daily medication dose.
Concurrent users (n = 4,369) were propensity score matched 1:1 with benzodiazepine-only users, opioid-only users, and nonusers. One year after medication start, the concurrent cohort had higher rates of all-cause mortality (116 deaths) relative to benzodiazepine-only (75 deaths; adjusted hazard ratio = 1.52; 95% CI, 1.14-2.03), opioid-only (67 deaths; 1.76; 95% CI, 1.32-2.35), and nonuser (60 deaths; 1.85; 95% CI, 1.30-2.64) cohorts. Risk of overdose death was greater among patients in the concurrent cohort relative to patients in the benzodiazepine-only (adjusted subhazard ratio = 2.59; 95% CI, 1.00-6.66), opioid-only (2.58; 95% CI, 1.09-6.11), and nonuser (9.16; 95% CI, 2.27-37.02) cohorts. For circulatory disease-related deaths, the adjusted subhazard ratio for concurrent medication users was 1.81 (95% CI, 1.01-3.24) relative to nonusers.
New coprescription of opioids and benzodiazepines was associated with increased all-cause mortality and overdose death compared with new prescription of benzodiazepines only, opioids only, or neither medication and increased circulatory disease-related death relative to neither medication.
阿片类药物和苯二氮䓬类药物通常是同时开的处方。同时使用这两种药物的死亡风险尚不清楚。
评估新处方阿片类药物和苯二氮䓬类药物的患者与仅处方苯二氮䓬类药物、仅处方阿片类药物或两种药物均未处方的患者相比，全因死亡率的风险。
这项基于倾向评分匹配的回顾性队列研究纳入了 2009 年 10 月 1 日至 2011 年 9 月 30 日期间接受退伍军人事务部（VA）医疗保健的 17476 名患有创伤后应激障碍的患者，这些患者通过 ICD-9-CM 代码 309.81 确诊。通过危险比和亚危险比评估 1 年全因死亡率和死因特异性死亡率，调整了倾向评分、年龄、基线精神和医疗合并症以及每日药物剂量。
在药物开始使用 1 年后，同时使用药物的队列（n=4369）与仅使用苯二氮䓬类药物、仅使用阿片类药物和未使用者的队列相比，全因死亡率更高（116 例死亡）。与仅使用苯二氮䓬类药物（调整后的危险比=1.52；95%CI，1.14-2.03）、仅使用阿片类药物（67 例死亡；1.76；95%CI，1.32-2.35）和未使用者（60 例死亡；1.85；95%CI，1.30-2.64）相比，同时使用药物的队列发生全因死亡的风险更高。与仅使用苯二氮䓬类药物（调整后的亚危险比=2.59；95%CI，1.00-6.66）、仅使用阿片类药物（2.58；95%CI，1.09-6.11）和未使用者（9.16；95%CI，2.27-37.02）相比，同时使用药物的队列中发生过量死亡的风险更高。对于与循环系统疾病相关的死亡，同时使用药物的患者的调整后亚危险比为 1.81（95%CI，1.01-3.24），高于未使用者。
与仅新处方苯二氮䓬类药物、仅新处方阿片类药物或两种药物均未处方相比，新处方同时使用阿片类药物和苯二氮䓬类药物与全因死亡率和过量死亡风险增加相关，与两种药物均未处方相比，与循环系统疾病相关的死亡风险增加。
