Despite being well aware that patients who take benzodiazepines while on buprenorphine are at increased risk for overdose and death, more than half of doctors surveyed still prescribed the two together, according to a study presented here.
Among surveyed physicians who prescribed the opioid partial agonist buprenorphine in 2015, 54.8% said they had also prescribed a benzodiazepine to the same patient. In 2016, 61.3% said they had prescribed the two together, reported Karen Gerlach, PhD, MPH, of Pinney Associates in Pittsburgh.
Recent FDA guidance could make this practice more common.
"We've been watching this for quite a few years," Gerlach told MedPage Today. "We were already seeing a lot of co-prescribing and even from the same prescriber."
The researchers separately looked at buprenorphine-related deaths and found that benzodiazepine was also involved in 25.7% of the cases reported to the FDA's Adverse Event Reporting System, and in 49.3% of buprenorphine-related deaths in Florida, which has more detailed information than the FDA's database. In only one of 71 Florida autopsies was buprenorphine alone determined to be the cause of death.
"As you can see there are some serious outcomes," said Gerlach, during a poster session at the American Society of Addiction Medicine 49th Annual Conference.
The researchers looked at surveys from 2014 to 2016, taken in consecutive years by 1,214 doctors who prescribed buprenorphine. The surveys were conducted as part of the Buprenorphine-Containing Transmucosal Products for Opioid Dependence Treatment (BTOD) Risk Evaluation and Mitigation Strategy (REMS) program from the FDA -- approved in 2013 in order to reduce the risks of accidental overdose and death from buprenorphine-containing agents, and to raise awareness of the risks among patients, clinicians, and pharmacists.
They reported that the vast majority of doctors prescribing buprenorphine (97.3% to 98.3%) indicated they were aware of the increased overdose and mortality risk when patients also took a benzodiazepine, a central nervous system (CNS) depressant commonly used for treating anxiety.