In this episode, I’ll discuss how often opioid overdose patients also have a benzodiazepine co-exposure.
When patients who overdose on opioids also have a benzodiazepine co-exposure, they are more likely to experience respiratory failure and less likely to be responsive to naloxone. But how common is co-exposure to benzodiazepines in patients with opioid overdose? A group of authors published an observational study that used data from 10 emergency departments and over 1400 patients to answer this question.
The study involved taking waste serum samples and using mass spectrometry to test for the presence of over 1200 psychoactive medications, metabolites, and substances. Of the cohort of patients with an opioid overdose, 29% also had co-exposure to benzodiazepines. This was broken down further by the authors as 20.5% being prescription benzos and 8.5% being novel benzos like bromazolam. The definition of a novel benzodiazepine is a non-FDA approved molecule with a core benzo-like structure. These benzos are illicitly obtained and used.
The median age of patients who had a novel benzo detected was about 7 years younger at 34 for novel vs 41 years for prescription benzos. Patients with novel benzos had significantly higher rates of naloxone non-response and had more than double the odds of requiring mechanical ventilation. In addition, those with novel benzos had higher rates of CNS depression or coma within the first hour of presentation.
The authors concluded:
Nearly a third of patients with confirmed opioid overdose presenting to the ED also had concomitant benzodiazepine exposures. Those with novel benzodiazepines had significantly higher odds of intubation, suggesting greater severity of overdose.
Without a clinically available test for novel benzos, there is no way to confirm their presence in a timely manner but it may be inferred by this data that an opioid overdose patient with a more severe presentation may also be affected by a novel benzodiazepine. Whether or not flumazenil would have any effect on novel benzos is unknown.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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