title: Benzodiazepine use during buprenorphine treatment for opioid dependence: clinical and safety outcomes.
abstract: BACKGROUND
  Prescribing benzodiazepines during buprenorphine treatment is a topic of active discussion. Clinical benefit is unclear. Overdose, accidental injury, and benzodiazepine misuse remain concerns. We examine the relationship between benzodiazepine misuse history, benzodiazepine prescription, and both clinical and safety outcomes during buprenorphine treatment.
  
  
  METHODS
  We retrospectively examined outpatient buprenorphine treatment records, classifying patients by past-year benzodiazepine misuse history and approved benzodiazepine prescription at intake. Primary clinical outcomes included 12-month treatment retention and urine toxicology for illicit opioids. Primary safety outcomes included total emergency department (ED) visits and odds of an ED visit related to overdose or accidental injury during treatment.
  
  
  RESULTS
  The 12-month treatment retention rate for the sample (N=328) was 40%. Neither benzodiazepine misuse history nor benzodiazepine prescription was associated with treatment retention or illicit opioid use. Poisson regressions of ED visits during buprenorphine treatment revealed more ED visits among those with a benzodiazepine prescription versus those without (p<0.001); benzodiazepine misuse history had no effect. The odds of an accidental injury-related ED visit during treatment were greater among those with a benzodiazepine prescription (OR: 3.7, p<0.01), with an enhanced effect among females (OR: 4.7, p<0.01). Overdose was not associated with benzodiazepine misuse history or prescription.
  
  
  CONCLUSIONS
  We found no effect of benzodiazepine prescriptions on opioid treatment outcomes; however, benzodiazepine prescription was associated with more frequent ED visits and accidental injuries, especially among females. When prescribing benzodiazepines during buprenorphine treatment, patients need more education about accidental injury risk. Alternative treatments for anxiety should be considered when possible, especially among females.
authors.affiliation: Harvard Medical School, United States; Massachussets General Hospital, United States. Electronic address: zschuman@partners.org.
authors.forename: Zev
authors.initials: Z
authors.lastname: Schuman-Olivier
authors.forename: Bettina B
authors.initials: BB
authors.lastname: Hoeppner
authors.forename: Roger D
authors.initials: RD
authors.lastname: Weiss
authors.forename: Jacob
authors.initials: J
authors.lastname: Borodovsky
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Shaffer
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Albanese
mesh_terms: D000059:Accidents / Q000639:trends; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D004632:Emergency Medical Services / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods* / Q000639:trends; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines; D002047:Buprenorphine
keywords: Accident; Benzodiazepine; Buprenorphine; Female; Opioid dependence; Utilization