What is it about?

We used pharmaceutical claims to analyze overdose events associated with benzodiazepines in patients with opioid use disorder. Even though buprenorphine treatment days were associated with a nearly 40% decrease in overdose risk, benzodiazepine treatment days correlated with a near-doubling of overdose risk. However, even for individuals taking both buprenorphine and benzodiazepines, buprenorphine appears to retain its protective benefit against overdose.

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Why is it important?

Up to a third of people who suffer opioid overdoses are also using benzodiazepines. Many people who are addicted to opioids also have anxiety or depression for which they have been prescribed a benzodiazepine. How to handle this combination has confounded psychiatrists and addiction specialists. The goal in this study was to learn about the risks and benefits of taking buprenorphine while also taking benzodiazepines. Our data suggests that dose reduction of benzodiazepines while maintaining buprenorphine treatment may provide the advantage of lowering drug-related poisoning risk.


I was inspired to conduct this study because benzodiazepine use is quite common in patients with opioid use disorder. In clinical practice, I have been challenged by the risk/benefit calculus of tapering benzodiazepines versus keeping benzodiazepines on board in patients receiving buprenorphine. It is well established that buprenorphine is strongly associated with lower risk of overdoses. However, buprenorphine has central nervous system depressing effects, and there previously has been controversy surrounding patients on buprenorphine maintenance who are simultaneously taking benzodiazepines, which also depress the central nervous system. Our results depict a robust association between buprenorphine treatment days and fewer overdose events, even among patients who are taking benzodiazepines. Though more research is needed in this area, my takeaway from this finding is that patients with opioid use disorder arguably should not be turned away from buprenorphine treatment, even if they are on benzodiazepines.

Kevin Xu
Washington University in Saint Louis

Read the Original

This page is a summary of: Association Between Benzodiazepine or Z-Drug Prescriptions and Drug-Related Poisonings Among Patients Receiving Buprenorphine Maintenance: A Case-Crossover Analysis, American Journal of Psychiatry, July 2021, American Psychiatric Association,
DOI: 10.1176/appi.ajp.2020.20081174.
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