Veterans at Higher Risk from Co-Prescription of Opioids and Benzodiazepines

A recent report indicates that veterans receiving both opioids and benzodiazepines from Department of Veterans Affairs (VA) doctors face an increased risk of mortality compared to those receiving alternative treatments.

Understanding Opioids and Benzodiazepines

Opioids are commonly prescribed for pain management, while benzodiazepines are often used to treat anxiety, seizures, insomnia, and panic disorders. Combining these medications, however, can lead to serious risks.

Risk of Mortality

A study by the National Academies of Sciences, Engineering, and Medicine, conducted upon congressional request, analyzed VA health records from 2007 to 2019. Researchers concluded that veterans receiving both opioids and benzodiazepines were at elevated risk of death.

Brian Strom, chair of the committee and executive vice president for health affairs at Rutgers University, explained, “We know opioids suppress the respiratory system. Combining them with benzodiazepines may enhance this effect.”

Previous Practices and Safety Guidelines

Between 2004 and 2009, 27% of veterans receiving opioids were also prescribed benzodiazepines by VA doctors. However, concerns over the combined use of these medications were first highlighted in clinical guidelines in 2010.

The VA has continuously updated its guidelines in 2017 and 2022, emphasizing safe prescribing practices.

Suicide Risk

The study found some evidence linking higher suicide rates to veterans co-prescribed opioids and benzodiazepines. However, the data on suicides was limited, making it challenging to draw definitive conclusions.

Strom indicated that the available data suggested benzodiazepines might mitigate suicide risk, though further research is needed.

VA’s Efforts in Reducing Prescriptions

Opioid prescriptions surged from 18.9% in 2004 to over 33% in 2013 among VA patients. However, in recent years, the VA has implemented innovative pain management strategies focusing on holistic care rather than medication reliance.

The VA reported in 2023 that it had reduced opioid prescriptions by 67%, dropping from almost 875,000 in 2012 to just over 289,000 by 2023.

Legislative Efforts

Legislators have introduced multiple bipartisan bills to investigate overmedication practices within the VA. Lawmakers remain concerned about the relationship between medication practices and veteran suicides.

Impact of Dosing Levels

Veterans were found to be at higher risk of dying when prescribed higher dosage levels of opioids or when there was rapid doctoral escalation. However, the study could not conclusively determine the impact on suicide risk due to a small sample size of suicide deaths.

Connection Between Benzodiazepines and Suicide Rates

The VA’s 2024 suicide report indicates that suicide rates among veterans with sedative use disorder, often linked to benzodiazepines, increased by 29.2% in 2022.

Conclusion

The study underscores the need for cautious medication practices, especially when combined therapy includes opioids and benzodiazepines. Continued research and monitoring are crucial in improving veteran care and reducing mortality risks.

As the VA continues to refine its guidelines and reduce reliance on opioid medications, further legislative oversight can help ensure that veterans receive appropriate and safe medical treatments.

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