Risk Factors of Prescription Opioid Overdose Among Colorado Medicaid Beneficiaries

Dilokthornsakul, Piyameth; Moore, Gina; Campbell, Jonathan D.; Lodge, Robert; Traugott, Cathy; Zerzan, Judy; Allen, Richard R.; Page, Robert L.

doi:10.1016/j.jpain.2015.12.006

Cited by 69 publications

(47 citation statements)

References 13 publications

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“…Bivariate and multivariate results indicate that having ever overdosed was associated with regular nonmedical benzodiazepine use among this group of young adult nonmedical opioid users; this is consistent with the results of Dilokthornsakul et al (2016) and Dietze et al (2005) who found that using benzodiazepines in conjunction with opioids at a minimum doubled the risk for overdose. Our findings affirm those of other studies that demonstrate heightened risk for overdose when benzodiazepines are used concurrently with opioids (Chan et al, 2006; Jann et al, 2014; Jones et al, 2015; Kerr et al, 2007; McGregor et al, 1998; Toblin et al, 2010).…”

Section: Discussionsupporting

confidence: 87%

“…The nonmedical use of benzodiazepines among opioid users is a serious concern as benzodiazepines can markedly increase the harmful effects of opioids, particularly risk for fatal and non-fatal overdose (Chan, Stajic, Marker, Hoffman, & Nelson, 2006; Dietze, Jolley, Fry, & Bammer, 2005; Dilokthornsakul et al, 2016; Jann, Kennedy, & Lopez, 2014; Jones & McAninch, 2015; Kerr et al, 2007; Perret, Deglon, Kreek, Ho, & La Harpe, 2000; Toblin, Paulozzi, Logan, Hall, & Kaplan, 2010; White & Irvine, 1999). While opioids are the most common drug class involved in overdose, most overdoses involve more than one substance (McGregor, Darke, & Christie, 1998; Oliver & Keen, 2003; Ward & Barry, 2001; Wunsch, Nakamoto, Behonick, & Massello, 2009).…”

Section: Introductionmentioning

confidence: 99%

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High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City

Mateu‐Gelabert

Jessell

Goodbody

et al. 2017

International Journal of Drug Policy

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Background Benzodiazepines are a widely prescribed psychoactive drug; in the U.S., both medical and nonmedical use of benzodiazepines has increased markedly in the past 15 years. Long-term use can lead to tolerance and dependence, and abrupt withdrawal can cause seizures or other life-threatening symptoms. Benzodiazepines are often used nonmedically in conjunction with other drugs, and with opioids in particular a combination that can increase the risk for fatal and non-fatal overdose. This mixed-methods study examines nonmedical use of benzodiazepines among young adults in New York City and its relationship with opioid use. Methods For qualitative analysis, 46 90-minute semi-structured interviews were conducted with young adult opioid users (ages 18–32). Interviews were transcribed and coded for key themes. For quantitative analysis, 464 young adult opioid users (ages 18–29) were recruited using Respondent-Driven Sampling and completed structured interviews. Benzodiazepine use was assessed via a self-report questionnaire that included measures related to nonmedical benzodiazepine and opioid use. Results Participants reported using benzodiazepines nonmedically for a wide variety of reasons, including: to increase the high of other drugs; to lessen withdrawal symptoms; and to come down from other drugs. Benzodiazepines were described as readily available and cheap. There was a high prevalence (93%) of nonmedical benzodiazepine use among nonmedical opioid users, with 57% reporting regular nonmedical use. In bivariate analyses, drug-related risk behaviours such as polysubstance use, drug binging, heroin injection and overdose were strongly associated with regular nonmedical benzodiazepine use. In multivariate analysis, growing up in a middle-income household (earning between $51,000 and $100,000 annually), lifetime overdose experience, having ever used cocaine regularly, having ever been prescribed benzodiazepines, recent drug binging, and encouraging fellow drug users to use benzodiazepines to cope with opioid withdrawal were consistently strong predictors of regular nonmedical benzodiazepine use. Conclusion Nonmedical benzodiazepine use may be common among nonmedical opioid users due to its drug-related multi-functionality. Harm reduction messages should account for the multiple functions benzodiazepines serve in a drug-using context, and encourage drug users to tailor their endorsement of benzodiazepines to peers to include safer alternatives.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City

Mateu‐Gelabert

Jessell

Goodbody

et al. 2017

International Journal of Drug Policy

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“…These limitations are persistent in the literature. We reviewed 6 additional opioid safety studies that were published after the CDC guidelines (until December 31, 2016) and 1 study previously published but not cited in the guidelines; these studies shared similar limitations …”

Section: Discussion and Recommendationsmentioning

confidence: 99%

Methodologic limitations of prescription opioid safety research and recommendations for improving the evidence base

Ranapurwala

Naumann

Austin

et al. 2018

Pharmacoepidemiology and Drug

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“…One of the leading causes of death in this population is opioid overdose (Degenhardt, Larney, Randall, Burns, & Hall, 2014;Stenbacka, Leifman, & Romelsjo, 2010). There is extensive knowledge about possible risk factors for overdose such as, being outside of drug-treatment, older age, depression, length of injecting career and combining opioid injections with alcohol and/or benzodiazepine use (Bartoli et al, 2014;Bohnert, Roeder, & Ilgen, 2011;Clausen, Anchersen, & Waal, 2008;Dilokthornsakul et al, 2016;Jones & McAninch, 2015;Riley et al, 2016;Wichmann, Nielsen, Siersma, & Rasmussen, 2013;Winstanley & Clark, 2015). Despite this knowledge, mortality rates due to overdose remain high in many developed countries (Emcdda, 2015).…”

Section: Introductionmentioning

confidence: 99%

Emergency service use is common in the year before death among drug users who die from an overdose

Gjersing

Jonassen

Bramness

et al. 2016

Journal of Substance Use

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AimsThis study compares the characteristics of those who were or were not attended by the emergency services in the year before death. It describes the reasons for emergency service attendance and the prevalence of such attendance. It reports the number of days between the last emergency service attendance and death and examines contact with other health and social services and the association of this with emergency service attendance. Finally, it examines the association between frequency of emergency service attendance and frequency of contact with other services. MethodsA retrospective registry study where all overdose fatalities (n=231) in Oslo, Norway (2006Norway ( -2008 were identified through the National Cause of Death Registry and linked with data from other health and social services. ResultsOverall, 61% were emergency service attendees and 18% were frequent attendees. Somatic complaints were the most common reason for attendance. Attendees were more known to a number of other services compared to the non-attendees. Furthermore, there was an association between frequency of emergency service attendance and frequency of contact with other services. ConclusionsScreening for drug use among emergency service attendees may be a way to identify those at risk of overdose death and enable the introduction of additional interventions.

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Risk Factors of Prescription Opioid Overdose Among Colorado Medicaid Beneficiaries

Cited by 69 publications

References 13 publications

High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City

High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City

Methodologic limitations of prescription opioid safety research and recommendations for improving the evidence base

Emergency service use is common in the year before death among drug users who die from an overdose

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