1
|
Moses J, Korona-Bailey J, Mukhopadhyay S. Exploring trends in benzodiazepine-positive fatal drug overdoses in Tennessee, 2019-2021. Ann Med 2023; 55:2287194. [PMID: 38039554 PMCID: PMC10836290 DOI: 10.1080/07853890.2023.2287194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Benzodiazepine-positive overdoses increased between 2019 and 2021 in Tennessee. We sought to determine the changes in the number and characteristics of prescription and illicit benzodiazepine-positive fatal drug overdoses during this period. MATERIALS AND METHODS A statewide study was conducted to determine changes in the number and characteristics of benzodiazepine-positive drug overdose decedents using 2019-2021 data from the Tennessee State Unintentional Drug Overdose Reporting System. The analyses were limited to Tennessee residents aged ≥ 18 years. A benzodiazepine-positive overdose was defined as any benzodiazepine on toxicology, regardless of the presence of other substances. Frequencies were generated to compare demographics, circumstances, prescription history, and toxicology between 2019 and 2021 for illicit and prescription benzodiazepine-positive fatal overdoses. RESULTS Between 2019 and 2021, 1666 benzodiazepine-positive unintentional or undetermined fatal drug overdoses out of 5916 total overdoses that occurred among adult Tennessee residents with available toxicological information. Prescription benzodiazepines were identified in 80.7% of deaths, whereas illicit benzodiazepines were identified in 12.0% of deaths. Many decedents had an anxiety disorder (45.5%), while over half of all decedents had a history of substance use disorder (52.3%). Most benzodiazepine-positive overdoses involved fentanyl (71.3%). CONCLUSIONS This analysis can inform local and regional public health workers to implement focused prevention and intervention efforts for people with co-occurring mental health conditions and substance use disorders to curb overdose epidemics among persons using benzodiazepines in Tennessee. Public health campaigns should focus on educating people on appropriate prescription medication use and the dangers of obtaining substances illicitly. Given the high proportion of opioids in this population, further education also is needed on the dangers of polysubstance drug use. The differences between prescription and illicit benzodiazepine-positive fatal overdoses indicate the need to develop substance-specific prevention and treatment strategies.
Collapse
Affiliation(s)
| | | | - Sutapa Mukhopadhyay
- TN Department of Health, Office of Informatics and Analytics, Nashville, TN, USA
| |
Collapse
|
2
|
Timko C, Hoggatt KJ, Esmaeili A, Lewis E, Lor MC, Maust DT, Nevedal AL. Long-Term Benzodiazepine Use and Discontinuation Among Patients in the U.S. Veterans Health Administration. Psychiatr Serv 2022; 73:1217-1224. [PMID: 35502517 DOI: 10.1176/appi.ps.202100617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although long-term benzodiazepine use is not recommended, patients are often prescribed benzodiazepines for >30 days (long-term use). Data from the Veterans Health Administration (VHA) may inform efforts to discontinue such use. This study sought to describe benzodiazepine use and discontinuation among VHA patients and compared patients who continued and discontinued use. METHODS The study used nationwide electronic health record data for all VHA-enrolled patients (age ≥18) from fiscal year (FY) 2019 (N=6,032,613). The primary outcome, benzodiazepine discontinuation, was defined as no prescription refill for 120 days. RESULTS In FY2019, 3.5% of VHA enrollees were prescribed benzodiazepines for >30 days, which was 72.0% of those prescribed benzodiazepines. One-third of veterans prescribed long-term benzodiazepines discontinued use. Continuation was more likely among patients who were older, not Black, taking benzodiazepines longer, and taking higher doses. When demographic factors were controlled, patients who continued long-term use were more likely to have a diagnosis of anxiety, posttraumatic stress disorder (PTSD), bipolar disorder, or psychosis and less likely to have depression or an alcohol or drug use disorder. Continuation was associated with a lower likelihood of sleep and cardiopulmonary disorders and of dementia. CONCLUSIONS Higher discontinuation prevalence among patients with substance use disorders, dementia, or cardiopulmonary disorders is encouraging. However, the challenge remains of discontinuing long-term use among patients who are White, older, or diagnosed as having anxiety, PTSD, bipolar disorder, or psychosis. There is a need to identify provider, patient, and contextual factors driving long-term benzodiazepine use in these patient groups to effectively apply evidence-based discontinuation strategies.
Collapse
Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation (Timko, Lor, Nevedal) and Program Evaluation and Resource Center (Lewis), Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Timko); San Francisco VA Medical Center and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco (Hoggatt); VA Health Economics Resource Center, Menlo Park, California (Esmaeili); Department of Psychiatry, University of Michigan, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor (Maust)
| | - Katherine J Hoggatt
- Center for Innovation to Implementation (Timko, Lor, Nevedal) and Program Evaluation and Resource Center (Lewis), Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Timko); San Francisco VA Medical Center and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco (Hoggatt); VA Health Economics Resource Center, Menlo Park, California (Esmaeili); Department of Psychiatry, University of Michigan, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor (Maust)
| | - Aryan Esmaeili
- Center for Innovation to Implementation (Timko, Lor, Nevedal) and Program Evaluation and Resource Center (Lewis), Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Timko); San Francisco VA Medical Center and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco (Hoggatt); VA Health Economics Resource Center, Menlo Park, California (Esmaeili); Department of Psychiatry, University of Michigan, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor (Maust)
| | - Eleanor Lewis
- Center for Innovation to Implementation (Timko, Lor, Nevedal) and Program Evaluation and Resource Center (Lewis), Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Timko); San Francisco VA Medical Center and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco (Hoggatt); VA Health Economics Resource Center, Menlo Park, California (Esmaeili); Department of Psychiatry, University of Michigan, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor (Maust)
| | - Mai Chee Lor
- Center for Innovation to Implementation (Timko, Lor, Nevedal) and Program Evaluation and Resource Center (Lewis), Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Timko); San Francisco VA Medical Center and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco (Hoggatt); VA Health Economics Resource Center, Menlo Park, California (Esmaeili); Department of Psychiatry, University of Michigan, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor (Maust)
| | - Donovan T Maust
- Center for Innovation to Implementation (Timko, Lor, Nevedal) and Program Evaluation and Resource Center (Lewis), Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Timko); San Francisco VA Medical Center and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco (Hoggatt); VA Health Economics Resource Center, Menlo Park, California (Esmaeili); Department of Psychiatry, University of Michigan, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor (Maust)
| | - Andrea L Nevedal
- Center for Innovation to Implementation (Timko, Lor, Nevedal) and Program Evaluation and Resource Center (Lewis), Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Timko); San Francisco VA Medical Center and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco (Hoggatt); VA Health Economics Resource Center, Menlo Park, California (Esmaeili); Department of Psychiatry, University of Michigan, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor (Maust)
| |
Collapse
|