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

Catherine Susan Best*, Catriona Matheson, James 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

1 Citation (Scopus)

Abstract

Objective To investigate the association between opioid replacement therapy (ORT) and benzodiazepine (BZD) coprescription and all-cause mortality compared with 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 46 899 participants died: 1398 while on coprescription and 4378 while on ORT only. The mortality per 100 person years was 3.11 during coprescription and 2.34 on ORT only. The adjusted HR for all-cause mortality was 1.17 (1.10 to 1.24). The adjusted HR 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 Coprescription of BZDs in ORT was associated with an increased risk of all-cause mortality, although with a small effect size than the international literature. Coprescribing was also associated with longer retention in treatment. Risk from BZD coprescription needs to be balanced against the risk from illicit BZDs and unplanned treatment discontinuation. A randomised controlled trial is urgently needed to provide a clear clinical direction. Trial registration number NCT04622995.


Trial registration number NCT04622995.

Original languageEnglish
Article numbere074668
Number of pages9
JournalBMJ Open
Volume14
Issue number3
DOIs
Publication statusPublished - 14 Mar 2024

Keywords

  • Clinical pharmacology
  • Epidemiology
  • Substance misuse

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