Association Between Benzodiazepine and Opioid Prescription and Mortality Among Patients in a Large Healthcare System

OBJECTIVE: Co-prescription of opioids and benzodiazepines (BDZ) is associated with adverse outcomes, including greater healthcare utilization and overdose risk. This study aims to examine opioid and BDZ co-prescription, dosing, and mortality among patients with and without opioid use disorder (OUD) in a large healthcare system. METHODS: Using data from the California state Prescription Drug Monitoring Program during 2010–2014 linked with a large healthcare system electronic health record database and mortality records from the Centers for Disease Control National Death Index, this study examined 5,202 patients (1,978 with OUD, 3,224 controls). Multiple logistic regression analyses were conducted to examine relationships between most recent BDZ and opioid prescription, and their interaction with respect to mortality. RESULTS: 10.5% of the sample died on or before December 31, 2014. 17.7% were prescribed BDZ during the final month of observation. Individuals with OUD were prescribed higher average BDZ and opioid doses than those without OUD. After adjusting for covariates, increased prescribed doses of BDZ (odds ratio [OR]=1.34, 95%CI: 1.15–1.55 per 10 mg/day increment) and opioids (OR=1.04, 95%CI: 1.02–1.05 per 10 mg/day increment) were positively associated with mortality. Non-OUD patients who received both BDZ and opioid prescriptions had a higher mortality than those who received only BDZ or opioids (The ratio of odds ratio (ROR) =3.83, 95%CI: 1.78–8.21). CONCLUSIONS: Study findings highlight significant mortality associated with the co-prescription of opioids and BDZ in a general healthcare setting. Further research is needed to elucidate factors associated with mortality among non-OUD patients who are co-prescribed opioids and BDZ.