Benzodiazepines and Alcohol Are Often Involved in Opioid Overdose Deaths

Opioid overdose is a growing cause of death in the US. The risk of fatal overdose from opioids is increased by the concomitant use of other sedating drugs such as benzodiazepines and alcohol. Researchers used data from a National Vital Statistics System database of all opioid-related poisoning deaths from 1999 to 2017 to characterize alcohol and benzodiazepine co-involvement. They also looked at correlations of alcohol co-involvement in opioid-related deaths with state-level heavy episodic drinking prevalence,* and of benzodiazepine co-involvement in opioid-related deaths with state-level benzodiazepine prescribing.**

• From 1999 to 2017, there were 399,230 reported poisoning deaths involving opioids; 66% of fatalities were men, and 51% were aged 35–54.
• Alcohol co-involvement in opioid-related deaths increased from 12% in 1999 to 15% in 2017; in the same period, benzodiazepine co-involvement in opioid-related deaths increased from 9% in to 21%.
• Across states, heavy episodic drinking was positively correlated with alcohol co-involvement in opioid-related deaths, and benzodiazepine prescribing was likewise positively correlated with benzodiazepine co-involvement in opioid-related deaths.

* Defined as ≥5 standard drinks for men and ≥4 for women on 1 occasion in the last month. Data from 2015–2017 Behavioral Risk Factor Surveillance System.

** Data from 2012 (most recent available).

Comments: This study shows that alcohol and benzodiazepines are often involved in opioid overdose deaths. Given the limitations of death reports, this data likely underestimates the prevalence. Nevertheless, this study underscores the importance of avoiding the co-prescribing of opioids and benzodiazepines, as well as addressing unhealthy alcohol use among individuals who use opioids (prescribed and non-prescribed).

Darius A. Rastegar, MD

Reference: Tori ME, Larochelle MR, Naimi TS. Alcohol or benzodiazepine co-involvement with opioid overdose deaths in the United States, 1999–2017. JAMA Netw Open. 2020;3(4):e.202361.