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Reducing opioid overdose in patients taking buprenorphine

The study indicates that the drug is effective in opioid users who are taking benzodiazepines for anxiety, and other conditions

Even during the COVID-19 pandemic, opioid abuse has continued unabated in the United States, with an estimated 2.5 million or more Americans suffering from opioid use disorder. Most people treated for this disorder are given drugs, such as buprenorphine, that activate opioid receptors. But there is disagreement over whether it is safe to prescribe buprenorphine for people who also take benzodiazepines, which are likely addictive drugs prescribed for stress, sleep, and anxiety.

New research including medical data for more than 23,000 patients being treated for opioid use disorder supports the use of buprenorphine in patients who are also taking benzodiazepines. Researchers at Washington University School of Medicine in St. Louis found that the drug could protect opioid users from overdoses, even when those patients also take benzodiazepines, such as Valium, Xanax, and Ativan.

The study was published online March 3 at The American Journal of Psychiatry.

First, he said, “Buprenorphine has had very good results as a treatment for opioid use disorder, in part because patients can take their medication at home, which is different from other medications commonly used to treat the disorder such as methadone, which requires clinic visits.” The author is Kevin Zou, MD, MD. “Buprenorphine is known to save lives in patients with opioid use disorder, but because the drug has CNS depressant effects, there have been big questions about safety when patients also take benzodiazepines, which also depress the central nervous system. Moreover, our findings indicate that buprenorphine reduces the likelihood of an overdose, even in people who also take benzodiazepines. “

The research team investigated the issue in part because many treatment centers do not accept patients addicted to opioids and also take prescription benzodiazepines.

“As many as a third of people who experience opioid overdoses also have benzodiazepines in their systems,” Shaw said. “A lot of people turn away from buprenorphine treatment, or worse, their doctors are suddenly turning away from benzodiazepines, which can be very annoying. Our goal was to find out more about whether there are risks associated with taking buprenorphine while also taking benzodiazepines.”

Although buprenorphine is not the only drug used to treat opioid use disorder – other drugs include methadone and naltrexone – the researchers focused on buprenorphine in this study because patients often can fill out prescriptions for the drug at a pharmacy and take the medication at home.

Shaw and colleagues – including Laura J. Bierut, MD, professor of graduate psychiatry, and Richard A. Grucza, Ph.D., professor in the Department of Family and Community Medicine at St. Louis University – analyzed data collected by insurance companies tracked emergency room visits that included 23036 An unidentified patient with buprenorphine prescription

“We have all heard of the devastation caused by opioids such as heroin and fentanyl, but the use of benzodiazepines can also be addictive and deadly,” said Beirut, one of the study’s senior investigators. “Many opioid addicts also suffer from the anxiety or depression that they have been prescribed a benzodiazepine drug. Psychiatrists and addiction medicine professionals have confused how to deal with this combination, but we think these results provide some clarity.”

Every patient identified who was tracked into the database was exposed to at least one overdose, but none experienced a fatal overdose. Each individual was followed for two years to track the prescriptions they filled out and how often each person in the emergency department ended up with drug-related poisoning. Although the database only tracked non-fatal overdoses, Shaw explained that these events account for the vast majority of drug-related poisonings, adding that those who experience non-fatal overdoses are at the ultimate risk of dying from a drug overdose.

“These are patients who are at high risk, and we know that when someone takes an overdose once, they are likely to return to the emergency department again for the same reason,” said Shaw.

In an effort to find out if buprenorphine helps prevent overdoses and whether taking this drug with benzodiazepines might increase the risk of overdose, researchers discovered that opioid users who took buprenorphine had a 40% reduction in the risk of an overdose compared to not receiving treatment. . Meanwhile, opioid users with benzodiazepine prescriptions who did not take buprenorphine were twice as likely to overdose as they put them in the hospital.

“Even for people taking benzodiazepines, buprenorphine had a protective effect,” Shaw said. “Buprenorphine did not protect these patients from overdose as much as it did users against not taking benzodiazepines, but it still reduced the possibility of overdosing.”

What this means about the drug interactions between buprenorphine, opioids and benzodiazepines is still not entirely clear. But what is clear, Shaw said, is that prescribing buprenorphine to treatment opioid users can protect them from an overdose, even if they are also taking a benzodiazepine drug.

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Xu K, Borodovsky J, Presnall N, Mintz C, Hartz S, Bierut LJ, Grucza RA. Relationship between benzodiazepine and Z drug prescriptions and drug-related toxicity among patients receiving buprenorphine maintenance: a case-crossover analysis. The American Journal of PsychiatryPosted online March 3, 2021.

This work was supported by the National Institute of Mental Health, the National Institute of Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse and the National Center for Transformational Science Development at the National Institutes of Health (NIH). Grant numbers R25 MH112473-01, R21 AA024888-01, UL1 TR002345, R21 DA044744, U10 AA008401, R01 DA036583, K12 DA041449, R21 AA02568901, F32 AA027941, R24 HS19455. Additional support from the Center for Administrative Data Research (CADR) at the University of Washington.

The 1,500 physicians on the faculty at Washington University School of Medicine are the medical staff at Barnes-Jewish Hospitals and St. Louis Children’s Hospital. The College of Medicine is a leader in medical research, education, and patient care, and is ranked among the top 10 medical schools in the country by US News & World Report. Through its affiliations with Barnes-Judean and St. Louis Children’s Hospitals, the School of Medicine is affiliated with BJC HealthCare.

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