Dangerously numb: opioids, benzodiazepines, chronic pain, and posttraumatic stress disorder

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The study by Gressler et al.5 is an important and timely study concerning the risk of adverse outcomes associated with the concurrent prescribing of opioids and benzodiazepines in the entire Veteran patient population between 2008 and 2012. Recent studies have documented an increased risk of overdose death in veterans prescribed both opioids and benzodiazepines. From 2004 to 2009, 27% of veterans receiving opioids also received benzodiazepines. This group accounted for half of overdose deaths during that period. Adjusted risk for death was nearly 4 times higher in the concurrent prescription group, with the risk increasing as the benzodiazepine dose increased.13 The study by Gressler et al.5 advances the field through careful attention to confounding by indication. This is important because the patients who receive opioids and benzodiazepines are not the same patients as those who receive only opioids. The differences between these groups must be controlled for in any attempt to quantify the risk associated with the benzodiazepine prescription itself.
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