The Safety of Benzodiazepines and Opioids in the Geriatric Population: An Analysis of Patient Safety Events Reported by Hospitals and Ambulatory Surgical Facilities

Authors

DOI:

https://doi.org/10.33940/data/2021.12.5

Keywords:

benzodiazepine, opioid, naloxone, patient safety,, medication safety, overdose, adverse drug reaction, medication error

Abstract

Visual abstract for Benos article.

Benzodiazepines may increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in patients 65 years and older. The concomitant use of benzodiazepines and opioids may also be inappropriate for older adults due to the increased risk of overdose. We searched the Pennsylvania Patient Safety Reporting System (PA-PSRS) for reports of patient safety events related to the concomitant use of benzodiazepines and opioids in older adults in order to gain a better understanding of the potential risks of using these medications in combination. We identified 80 reports in which a patient may have experienced an adverse drug reaction (ADR) to the combined use of a benzodiazepine and an opioid pain medication. Reports were reviewed to determine the ADR(s) experienced by the patient. Changes in mental status were most common, occurring in more than two-thirds of reports (68.8%; 55 of 80), followed by respiratory reactions (51.3%; 41 of 80) and cardiovascular reactions (25.0%; 20 of 80). In over two-thirds of reports (70.0%; 56 of 80), the patient received a reversal agent, either flumazenil (10.7%; 6 of 56) or naloxone (35.7%; 20 of 56), or both (53.6%; 30 of 56). The inappropriate use of benzodiazepines and opioid pain medications in combination among patients 65 years and older is a growing problem, and an increased awareness may be the first step for providers to begin addressing it.

Author Biography

Elizabeth Kukielka, PharmD, MA, RPh, Patient Safety Authority

Elizabeth Kukielka (ekukielka@pa.gov) is a patient safety analyst on the Data Science and Research team at the Patient Safety Authority. Before joining the PSA, she was a promotional medical writer for numerous publications, including Pharmacy Times and The American Journal of Managed Care. Kukielka also worked for a decade as a community pharmacist and pharmacy manager, with expertise in immunization delivery, diabetes management, medication therapy management, and pharmacy compounding.

References

Kang M, Galuska MA, Ghassemzadeh S. Benzodiazepine Toxicity. StatPearls. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482238/. Published January 2021. Updated July 26, 2021. Accessed October 8, 2021. PubMed PMID: 29489152.

American Geriatrics Society Beers Criteria Update Expert Panel, Fick DM, Semla TP, Steinman M, Beizer J, Brandt N, et al. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-94. doi: 10.1111/jgs.15767. PubMed PMID: 30693946.

Medical Care Availability and Reduction of Error (MCARE) Act, Pub. L. No. 154 Stat. 13 (2002). https://www.health.pa.gov/topics/Documents/Laws%20and%20Regulations/Act%2013%20of%202002.pdf.

Edwards IR, Aronson JK. Adverse Drug Reactions: Definitions, Diagnosis, and Management. Lancet. 2000;356(9237):1255-9. Epub 2000/11/10. doi: 10.1016/s0140-6736(00)02799-9. PubMed PMID: 11072960.

Kepner S, Jones R. 2020 Pennsylvania Patient Safety Reporting: An Analysis of Serious Events and Incidents from the Nation’s Largest Event Reporting Database. Patient Saf. 2021;3(2):6-21. doi: 10.33940/data/2021.6.1.

FDA Warns About Serious Risks and Death When Combining Opioid Pain or Cough Medicines with Benzodiazepines; Requires Its Strongest Warning. Food and Drug Administration website. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-about-serious-risks-and-death-when-combining-opioid-pain-or. Published 2016. Updated September 20, 2017. Accessed April 1, 2021.

Reduce Risk of Opioid Overdose Deaths by Avoiding and Reducing Co-Prescribing Benzodiazepines. Centers for Medicare & Medicaid Services website. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE19011.pdf. Published 2019. Updated July 1, 2019. Accessed April 5, 2021.

Morimoto T, Gandhi TK, Seger AC, Hsieh TC, Bates DW. Adverse Drug Events and Medication Errors: Detection and Classification Methods. Qual Saf Health Care. 2004;13(4):306-14. Epub 2004/08/04. doi: 10.1136/qhc.13.4.306. PubMed PMID: 15289635; PubMed Central PMCID: PMCPMC1743868.

Danovitch I, Vanle B, Van Groningen N, Ishak W, Nuckols T. Opioid Overdose in the Hospital Setting: A Systematic Review. J Addict Med. 2020;14(1):39-47. Epub 2019/04/06. doi: 10.1097/ADM.0000000000000536. PubMed PMID: 30950913.

Herzig SJ, Stefan MS, Pekow PS, Shieh MS, Soares W, Raghunathan K, et al. Risk Factors for Severe Opioid-Related Adverse Events in a National Cohort of Medical Hospitalizations. J Gen Intern Med. 2020;35(2):538-45. Epub 2019/11/16. doi: 10.1007/s11606-019-05490-w. PubMed PMID: 31728892; PubMed Central PMCID: PMCPMC7018928.

Lyons PG, Snyder A, Sokol S, Edelson DP, Mokhlesi B, Churpek MM. Association Between Opioid and Benzodiazepine Use and Clinical Deterioration in Ward Patients. J Hosp Med. 2017;12(6):428-34. Epub 2017/06/03. doi: 10.12788/jhm.2749. PubMed PMID: 28574532; PubMed Central PMCID: PMCPMC5695213.

Chen DX, Yang L, Ding L, Li SY, Qi YN, Li Q. Perioperative Outcomes in Geriatric Patients Undergoing Hip Fracture Surgery With Different Anesthesia Techniques: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2019;98(49):e18220. Epub 2019/12/06. doi: 10.1097/md.0000000000018220. PubMed PMID: 31804347; PubMed Central PMCID: PMCPMC6919429.

Opperer M, Danninger T, Stundner O, Memtsoudis SG. Perioperative Outcomes and Type of Anesthesia in Hip Surgical Patients: An Evidence Based Review. World J Orthop. 2014;5(3):336-43. Epub 2014/07/19. doi: 10.5312/wjo.v5.i3.336. PubMed PMID: 25035837; PubMed Central PMCID: PMCPMC4095027.

Basques BA, Toy JO, Bohl DD, Golinvaux NS, Grauer JN. General Compared With Spinal Anesthesia for Total Hip Arthroplasty. J Bone Joint Surg Am. 2015;97(6):455-61. Epub 2015/03/20. doi: 10.2106/jbjs.N.00662. PubMed PMID: 25788301; PubMed Central PMCID: PMCPMC4357526.

Rana MV, Bonasera LK, Bordelon GJ. Pharmacologic Considerations of Anesthetic Agents in Geriatric Patients. Anesthesiol Clin. 2017;35(2):259-71. Epub 2017/05/21. doi: 10.1016/j.anclin.2017.01.011. PubMed PMID: 28526147.

Hazell L, Shakir SA. Under-Reporting of Adverse Drug Reactions: A Systematic Review. Drug Saf. 2006;29(5):385-96. Epub 2006/05/13. doi: 10.2165/00002018-200629050-00003. PubMed PMID: 16689555.

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Published

2021-12-17

How to Cite

Kukielka, E. (2021). The Safety of Benzodiazepines and Opioids in the Geriatric Population: An Analysis of Patient Safety Events Reported by Hospitals and Ambulatory Surgical Facilities. Patient Safety, 3(4), 42–49. https://doi.org/10.33940/data/2021.12.5

Issue

Section

Original Research and Articles
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