title: Benzodiazepine use among chronic pain patients prescribed opioids: associations with pain, physical and mental health, and health service utilization.
abstract: OBJECTIVE
  Benzodiazepines (BZDs) are commonly used by chronic pain patients, despite limited evidence of any long-term benefits and concerns regarding adverse events and drug interactions, particularly in older patients. This article aims to: describe patterns of BZDs use; the demographic, physical, and mental health correlates of BZD use; and examine if negative health outcomes are associated with BZD use after controlling for confounders.
  
  
  METHODS
  A national sample of 1,220 chronic noncancer pain (CNCP) patients prescribed long-term opioids.
  
  
  METHODS
  We report on baseline data from a prospective cohort study comparing four groups based on their current BZD use patterns. General demographics, pain, mental and physical comorbidity, and health service utilization were examined.
  
  
  RESULTS
  One-third (N = 398, 33%) of participants reported BZD use in the past month, and 17% (N = 212) reported daily BZD use. BZD use was associated with: 1) greater pain severity, pain interference with life, and lower feelings of self-efficacy with respect to their pain; 2) being prescribed "higher-risk" (>200 mg oral morphine equivalent) doses of opioids; 3) using antidepressant and/or antipsychotic medications; 4) substance use (including more illicit and injection drug use, alcohol use disorder, and daily nicotine use); and 5) greater mental health comorbidity. After controlling for differences in demographic characteristics, physical and mental health, substance use, and opioid dose, BZD use was independently associated with greater past-month use of emergency health care such as ambulance or accident and emergency services.
  
  
  CONCLUSIONS
  CNCP patients using BZDs daily represent a high-risk group with multiple comorbid mental health conditions and higher rates of emergency health care use. The high prevalence of BZD use is inconsistent with guidelines for the management of CNCP or chronic mental health conditions.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney, New South Wales, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
authors.forename: Raimondo
authors.initials: R
authors.lastname: Bruno
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Campbell
authors.forename: Briony
authors.initials: B
authors.lastname: Larance
authors.forename: Wayne
authors.initials: W
authors.lastname: Hall
authors.forename: Bianca
authors.initials: B
authors.lastname: Hoban
authors.forename: Milton L
authors.initials: ML
authors.lastname: Cohen
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines
keywords: Benzodiazepines; Chronic Noncancer Pain; Mental Health; Opioid