PMID- 34182374
OWN - NLM
STAT- MEDLINE
DCOM- 20210922
LR  - 20220802
IS  - 1879-0046 (Electronic)
IS  - 0376-8716 (Print)
IS  - 0376-8716 (Linking)
VI  - 225
DP  - 2021 Aug 1
TI  - Opioid deaths involving concurrent benzodiazepine use: Assessing risk factors 
      through the analysis of prescription drug monitoring data and postmortem 
      toxicology.
PG  - 108854
LID - S0376-8716(21)00349-5 [pii]
LID - 10.1016/j.drugalcdep.2021.108854 [doi]
AB  - BACKGROUND: A high proportion of opioid drug deaths involve concurrent 
      benzodiazepine use. To reduce the risk of drug overdose, various prescription 
      drug monitoring programs have been implemented. This study examined the impact of 
      concurrent benzodiazepine use on opioid-related deaths, and the utility of the 
      Michigan Automated Prescription System (MAPS) in predicting risk of opioid death. 
      METHODS: Wayne County Medical Examiner's Office cases from 2018 were examined in 
      terms of MAPS data and MAPS-derived drug risk scores, as well as postmortem 
      toxicology. Opioid death cases with concurrent benzodiazepine use were compared 
      to non-drug deaths. RESULTS: For cases with a MAPS history for 6 months preceding 
      death, the incidence of opioid prescriptions filled did not differ between 
      groups. In contrast, significantly more opioid death cases had filled a 
      benzodiazepine prescription; alprazolam prescription was the single best 
      predictor of opioid drug death. Groups differed in MAPS-calculated drug risk 
      scores, though these were less predictive of opioid death than some individual 
      measures of prescription drug use. In terms of postmortem toxicology, fentanyl 
      was the best discriminator between cohorts, with significant associations seen 
      for morphine, benzodiazepine, or cocaine use. Similar results were obtained in 
      the subset of subjects filling a prescription within a month of death, except 
      that MAPS risk scores no longer predicted drug deaths. CONCLUSION: MAPS scores 
      did not adequately predict risk of opioid-related death. Contrary to 
      expectations, prescription opioid use was not correlated with opioid-related 
      death, whereas concurrent use of opioids and benzodiazepines represented a highly 
      significant risk factor.
CI  - Copyright (c) 2021 The Author(s). Published by Elsevier B.V. All rights reserved.
FAU - Bannon, Michael J
AU  - Bannon MJ
AD  - Department of Pharmacology, Wayne State University School of Medicine, 540 E 
      Canfield St, Detroit, MI, 48201, USA. Electronic address: mbannon@med.wayne.edu.
FAU - Lapansie, Allyson R
AU  - Lapansie AR
AD  - Department of Pharmacology, Wayne State University School of Medicine, 540 E 
      Canfield St, Detroit, MI, 48201, USA.
FAU - Jaster, Alaina M
AU  - Jaster AM
AD  - Department of Pharmacology, Wayne State University School of Medicine, 540 E 
      Canfield St, Detroit, MI, 48201, USA.
FAU - Saad, Manal H
AU  - Saad MH
AD  - Department of Pharmacology, Wayne State University School of Medicine, 540 E 
      Canfield St, Detroit, MI, 48201, USA.
FAU - Lenders, Jayna
AU  - Lenders J
AD  - Department of Pharmacology, Wayne State University School of Medicine, 540 E 
      Canfield St, Detroit, MI, 48201, USA.
FAU - Schmidt, Carl J
AU  - Schmidt CJ
AD  - Department of Pathology, University of Michigan School of Medicine, 2800 Plymouth 
      Rd, Bldg. 35, Ann Arbor, MI, 48109, USA; Wayne County Medical Examiner's Office, 
      1300 E Warren Ave, Detroit, MI, 48207, USA.
LA  - eng
GR  - R01 DA047880/DA/NIDA NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20210624
PL  - Ireland
TA  - Drug Alcohol Depend
JT  - Drug and alcohol dependence
JID - 7513587
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Prescription Drugs)
RN  - 12794-10-4 (Benzodiazepines)
SB  - IM
MH  - Analgesics, Opioid/adverse effects
MH  - Benzodiazepines/adverse effects
MH  - *Drug Overdose/drug therapy/epidemiology
MH  - Drug Prescriptions
MH  - Humans
MH  - *Prescription Drug Monitoring Programs
MH  - *Prescription Drugs/adverse effects
MH  - Risk Factors
PMC - PMC8288032
MID - NIHMS1718400
OTO - NOTNLM
OT  - Alprazolam
OT  - Benzodiazepine
OT  - Michigan automated prescription system
OT  - Opioid death
OT  - Postmortem toxicology
OT  - Prescription drug monitoring program
COIS- Conflict of Interest Disclosures All authors declare no conflict of interest.
EDAT- 2021/06/29 06:00
MHDA- 2021/09/23 06:00
PMCR- 2022/08/01
CRDT- 2021/06/28 20:28
PHST- 2020/12/24 00:00 [received]
PHST- 2021/05/21 00:00 [revised]
PHST- 2021/05/21 00:00 [accepted]
PHST- 2021/06/29 06:00 [pubmed]
PHST- 2021/09/23 06:00 [medline]
PHST- 2021/06/28 20:28 [entrez]
PHST- 2022/08/01 00:00 [pmc-release]
AID - S0376-8716(21)00349-5 [pii]
AID - 10.1016/j.drugalcdep.2021.108854 [doi]
PST - ppublish
SO  - Drug Alcohol Depend. 2021 Aug 1;225:108854. doi: 
      10.1016/j.drugalcdep.2021.108854. Epub 2021 Jun 24.