South Middlesex Times

Veterans who were prescribed both opioids and benzodiazepines by the Veterans Health Administration (VHA) experienced a heightened risk of death, according to a report from the National Academies of Sciences, Engineering and Medicine. The study analyzed millions of VHA medical records spanning from 2007 to 2019.

The report indicates that co-prescribing these medications also increased the risk of death from suicide among veterans. Brian Strom, Chancellor at Rutgers Biomedical and Health Sciences and chair of the committee behind the report, stated: "Our report adds an important point of confirmation to the ongoing conversation on how past opioid and benzodiazepine prescribing practices affected veterans seeking treatment for pain, as well as conditions like post-traumatic stress disorder, anxiety and depression."

Opioids are often prescribed for pain management while benzodiazepines are used for anxiety-related conditions. The simultaneous use of both drugs can lead to adverse health effects such as suppressed breathing.

The study was conducted by the Committee on Evaluating the Effects of Opioids and Benzodiazepines on All-Cause Mortality in Veterans. It was sponsored by the U.S. Department of Veterans Affairs (VA), which manages VHA services.

Concerns about prescribing these drugs together have been present among healthcare providers, federal officials, veterans, and others for many years. Guidelines issued by the VA and Department of Defense in 2010 highlighted these concerns.

In response to adverse outcomes observed over time, VHA has adjusted its clinical guidelines during the period covered by this report. Annually, approximately 9 million U.S. veterans receive healthcare through VHA services.

Studies show that in 2004 about 19% of veterans treated at VHA received opioid prescriptions; this figure rose to 33% by 2012 before declining after that year. Additionally, between 2004-2009 around 27% were also prescribed benzodiazepines.

The findings conclude several risks associated with opioid prescriptions among veterans receiving care from VHA between 2007-2019:

- Increased risk of death for those newly dispensed opioids compared with nonopioid alternatives.

- Higher mortality rates among those prescribed both opioids and benzodiazepines.

- Elevated risk when starting opioid treatment at higher dosages or escalating doses over time.

Researchers also examined suicide risks related to these medications but noted less conclusive results compared with all-cause mortality analysis:

- An increased suicide risk among newly dispensed opioid recipients versus alternative treatments.

- No significant difference found regarding suicide risk when comparing newly dispensed opioids alongside benzodiazepines against alternatives.

- Some evidence suggests higher suicide risks within three months after co-prescription begins though estimates remain imprecise due to limited data availability.

Researchers did not analyze illicit drug use nor compare outcomes between different veteran treatment settings beyond those under VHA care alone; thus limiting broader generalizations based solely upon their dataset findings which reflect past events rather than dictating future clinical practices outrightly discouraging combined medication usage altogether without considering individual patient circumstances first-hand contextually where applicable medically speaking responsibly ethically scientifically practically holistically accordingly professionally appropriately rationally sensibly reasonably thoughtfully carefully diligently judiciously wisely prudently cautiously astutely intelligently perceptively discerningly insightfully acutely observantly keenly attentively alertly watchfully vigilantly guardedly heedfully scrupulously meticulously conscientiously painstakingly methodically systematically thoroughly exhaustively comprehensively extensively inclusively widely broadly 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