People who use prescription opioid painkillers along with the so-called Z-drugs (zolpidem, zopiclone, and zaleplon) for insomnia have a significantly higher risk of overdose than people who use opioids alone, according to a report in AJP in Advance.
“[T]he potential implications of these findings are substantial given the growing number of opioid-treated patients receiving Z-drugs, which we estimated to be about 1.2 million individuals in the United States, based on the 2013–2014 NHANES survey,” wrote Alejandro Szmulewicz, M.D., M.P.H., of the Harvard T.H. Chan School of Public Health and colleagues.
Using the IBM Marketscan Commercial and Medicare Supplemental Database, Szmulewicz and colleagues analyzed data on patients 15 to 85 years of age who had filled an opioid prescription between January 1, 2004, and December 31, 2017. The authors compared 510,529 patients within this group who also began taking Z-drugs with an equal number of patients who were taking opioids alone. The primary outcome of interest was any hospitalization or emergency department visit due to an overdose within 30 days.
There were 217 overdose events per 41,344 person-years among patients taking both Z-drugs and opioids, compared with 57 overdose events per 39,705 person-years among patients taking opioids alone. After controlling for all confounding factors, the researchers found that patients who had prescriptions for both Z-drugs and opioids were more than two times as likely to overdose as those taking only opioids.
“Although Z-drugs are widely perceived as safe, drug-induced respiratory depression has been reported in association with their use,” Szmulewicz and colleagues wrote. “Clinicians need to weigh this risk when considering whether to co-prescribe Z-drugs to patients taking prescription opioids.”
For related information, see the Psychiatric News article “Synthetic Opioid Overdose Deaths Soar.”
(Image: iStock/Mladen Zivkovic)
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