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

Abstract

ObjectiveTo investigate the association between opioid replacement therapy (ORT) and benzodiazepine (BZD) coprescription and all-cause mortality compared with the prescription of ORT alone.DesignPopulation-based cohort study.SettingScotland, UK.ParticipantsParticipants were people prescribed ORT between January 2010 and end of December 2020 aged 18 years or above.Main outcome measuresAll-cause mortality, drug-related deaths and non-drug related deaths.Secondary outcomeORT continuous treatment duration.AnalysisCox regression with time-varying covariates.ResultsDuring 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).ConclusionCoprescription 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 numberNCT04622995.