Association between benzodiazepine co-prescription and mortality in people on opioid replacement therapy: a population-based cohort study

Catherine Best*, Catriona Matheson, Roy Robertson, Trina Ritchie, Fiona Cowden, Josh Dumbrell, Clare Duncan, Karthigayan Kessavalou, Caroline Woolston, Joe Schofield

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Objective: To investigate the association between Opioid Replacement Therapy (ORT) and benzodiazepine co-prescription and all-cause mortality compared to the prescription of ORT alone.

Design: Population based cohort study

Setting: Scotland, UK.

Participants: Participants were people prescribed ORT between January 2010 and end of December 2020 aged 18 years or above.

Main outcome measures: all-cause mortality, drug related deaths and non-drug related deaths. Secondary outcome: ORT continuous treatment duration.

Analysis: Cox regression with time-varying covariates.

Results: During follow up 5776 of 46899 participants died: 1398 while on co-prescription and 4378 while on Opioid Replacement Therapy only. The mortality per 100 person years was 3.11 during co-prescription and 2.34 on ORT only. The adjusted hazard ratio for all-cause mortality was 1.17 (1.10 to 1.24). The adjusted hazard ratio for drug related death was 1.14 (95% CI 1.04 to 1.24) and the hazard for death not classified as drug-related was 1.19 (95% CI 1.09 to 1.30).

Conclusion: Co-prescription of benzodiazepines in opioid replacement therapy increased risk of all cause mortality, although less than the international literature. Co-prescribing was also associated with longer retention in treatment. Risk from benzodiazepine co-prescription needs to be balanced against the risk from illicit benzodiazepines and unplanned treatment discontinuation. A randomised controlled trial is urgently needed to provide clear clinical direction.
Original languageEnglish
Article numbere074668
Number of pages9
JournalBMJ Open
Volume14
Issue number3
DOIs
Publication statusPublished - 14 Mar 2024

Keywords / Materials (for Non-textual outputs)

  • benzodiazepines
  • opioid replacement therapy
  • mortality
  • treatment retention
  • survival analysis
  • Scotland

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