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The following is a summary of “Association between benzodiazepine co-prescription, opioid agonist treatment and mortality: a systematic review,” published in the October 2024 issue of Psychiatry by Hestevik et al. 

Opioid agonist treatment (OAT) is preferred for individuals with opioid dependence due to improved retention and reduced mortality, but benzodiazepine co-dependence among patients on OAT is linked to increased mortality. 

Researchers conducted a systematic review to examine the association between benzodiazepine co-prescription during OAT and mortality. 

They searched MEDLINE, Embase, PsychINFO, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Epistemonikos for reports from inception to June 2021, updated in February 2024. They included studies comparing mortality rates in patients on OAT with and without benzodiazepine co-prescription. Screened studies were reviewed by 2, extracted data, and bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Meta-analyses combined effect estimates, and the GRADE approach evaluated their certainty. 

The results showed that 6 observational studies (N = 84,452) from Sweden, Scotland, Canada, England, and the USA found moderate-certainty evidence linking benzodiazepine prescription to higher all-cause mortality on OAT (HR 1.83; 95% CI 1.59 to 2.11). Moderate-certainty evidence also associated benzodiazepine prescription with higher non-drug-induced mortality during OAT and the entire observation period (HR 1.73; 95% CI 1.33 to 2.25 and HR 2.02; 95% CI 1.29 to 3.18). Low-certainty evidence suggested an association with higher drug-induced mortality on OAT (HR 2.36; 95% CI 1.38 to 4.0). Very low-certainty evidence linked benzodiazepine prescription to higher all-cause and drug-induced mortality (HR 1.49; 95% CI 1.02 to 2.18 and HR 2.19; 95% CI 0.80 to 6.0). 

The study concluded that prescribed benzodiazepine use is likely associated with increased all-cause and non-drug-induced mortality risks in patients on OAT, though uncertainties exist due to methodological issues. 

Source: bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-06191-3