Co-prescribing of opioids and benzodiazepines/Z-drugs associated with all-cause mortality—A population-based longitudinal study in primary care with weak opioids most commonly prescribed
Funding Information: This research was supported by the Fund of Scientific Research of the Pharmaceutical Society of Iceland and the Research Fund of the Icelandic College of Family Physicians. Publisher Copyright: Copyright © 2022 Linnet, Thorsteinsdottir, Sigurdsson, Sigurdsson and Gudmundsson. In...
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ftopinvisindi:oai:opinvisindi.is:20.500.11815/3795 2023-11-12T04:19:35+01:00 Co-prescribing of opioids and benzodiazepines/Z-drugs associated with all-cause mortality—A population-based longitudinal study in primary care with weak opioids most commonly prescribed Linnet, Kristjan Thorsteinsdottir, Heidrun Sjofn Sigurdsson, Johann Agust Sigurdsson, Emil Larus Gudmundsson, Larus Steinthor Faculty of Medicine Faculty of Pharmaceutical Sciences 2022-09-06 1060638 932380 https://hdl.handle.net/20.500.11815/3795 https://doi.org/10.3389/fphar.2022.932380 en eng Frontiers in Pharmacology; 13() http://www.scopus.com/inward/record.url?scp=85138392125&partnerID=8YFLogxK Linnet , K , Thorsteinsdottir , H S , Sigurdsson , J A , Sigurdsson , E L & Gudmundsson , L S 2022 , ' Co-prescribing of opioids and benzodiazepines/Z-drugs associated with all-cause mortality—A population-based longitudinal study in primary care with weak opioids most commonly prescribed ' , Frontiers in Pharmacology , vol. 13 , 932380 , pp. 932380 . https://doi.org/10.3389/fphar.2022.932380 1663-9812 64937790 94885ac9-9c7a-4e7c-9f8c-b6ec6f50cf32 85138392125 36147347 https://hdl.handle.net/20.500.11815/3795 doi:10.3389/fphar.2022.932380 info:eu-repo/semantics/openAccess benzodiazepines/Z-drugs long-term co-prescribing mortality risk primary care weak opioids Pharmacology Pharmacology (medical) /dk/atira/pure/researchoutput/researchoutputtypes/contributiontojournal/article 2022 ftopinvisindi https://doi.org/20.500.11815/379510.3389/fphar.2022.932380 2023-11-01T23:55:24Z Funding Information: This research was supported by the Fund of Scientific Research of the Pharmaceutical Society of Iceland and the Research Fund of the Icelandic College of Family Physicians. Publisher Copyright: Copyright © 2022 Linnet, Thorsteinsdottir, Sigurdsson, Sigurdsson and Gudmundsson. Introduction: The risk of mortality associated with the co-prescribing of benzodiazepines and opioids has been explored in a number of papers mainly focusing on strong opioids. The mortality risk associated with the use of weak opioids has not been dealt with to a similar extent. Objective: To assess the mortality risk in primary care patients with consistent 3-year co-prescribing of benzodiazepine/Z-drugs (benzodiazepine receptor modulators) and mainly weak opioids (codeine, tramadol). Methods: Of 221,804 patients contacting the primary healthcare centres, 124,436 were selected for further analysis, 88,832 participants fulfilled the inclusion criteria, aged 10–69 years and were divided into four groups with neither any use of benzodiazepines/Z-drugs nor opioids as Group 1, 3 years’ use of opioids and no/minimal benzodiazepines/Z-drugs as Group 2, with benzodiazepines/Z-drugs and no/minimal opioids as Group 3, and finally both benzodiazepines/Z-drugs and opioids as Group 4. Hazard ratios were calculated with the no-drug group as a reference, using Cox proportional hazards regression model adjusted for age, sex, number of chronic conditions and cancer patients excluded (n = 87,314). Results: Hazard ratios for mortality increased both in Group 3 where it was 2.66 (95% CI 2.25–3.09) and in Group 4 where it was 5.12 (95% CI 4.25–6.17), with increased dose and higher number of chronic conditions. In Group 4 an opioid dose-dependent increase in mortality among persons using >1000 DDDs benzodiazepines/Z-drugs was observed when those on less than ≤300 DDDs of opioids with HR 4.94 (95% CI 3.54–6.88) were compared to those on >300 DDDs with HR 7.61/95% CI 6.08–9.55). This increase in mortality was not observed among ... Article in Journal/Newspaper Iceland Opin vísindi (Iceland) Frontiers in Pharmacology 13 |
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Open Polar |
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Opin vísindi (Iceland) |
op_collection_id |
ftopinvisindi |
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English |
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benzodiazepines/Z-drugs long-term co-prescribing mortality risk primary care weak opioids Pharmacology Pharmacology (medical) |
spellingShingle |
benzodiazepines/Z-drugs long-term co-prescribing mortality risk primary care weak opioids Pharmacology Pharmacology (medical) Linnet, Kristjan Thorsteinsdottir, Heidrun Sjofn Sigurdsson, Johann Agust Sigurdsson, Emil Larus Gudmundsson, Larus Steinthor Co-prescribing of opioids and benzodiazepines/Z-drugs associated with all-cause mortality—A population-based longitudinal study in primary care with weak opioids most commonly prescribed |
topic_facet |
benzodiazepines/Z-drugs long-term co-prescribing mortality risk primary care weak opioids Pharmacology Pharmacology (medical) |
description |
Funding Information: This research was supported by the Fund of Scientific Research of the Pharmaceutical Society of Iceland and the Research Fund of the Icelandic College of Family Physicians. Publisher Copyright: Copyright © 2022 Linnet, Thorsteinsdottir, Sigurdsson, Sigurdsson and Gudmundsson. Introduction: The risk of mortality associated with the co-prescribing of benzodiazepines and opioids has been explored in a number of papers mainly focusing on strong opioids. The mortality risk associated with the use of weak opioids has not been dealt with to a similar extent. Objective: To assess the mortality risk in primary care patients with consistent 3-year co-prescribing of benzodiazepine/Z-drugs (benzodiazepine receptor modulators) and mainly weak opioids (codeine, tramadol). Methods: Of 221,804 patients contacting the primary healthcare centres, 124,436 were selected for further analysis, 88,832 participants fulfilled the inclusion criteria, aged 10–69 years and were divided into four groups with neither any use of benzodiazepines/Z-drugs nor opioids as Group 1, 3 years’ use of opioids and no/minimal benzodiazepines/Z-drugs as Group 2, with benzodiazepines/Z-drugs and no/minimal opioids as Group 3, and finally both benzodiazepines/Z-drugs and opioids as Group 4. Hazard ratios were calculated with the no-drug group as a reference, using Cox proportional hazards regression model adjusted for age, sex, number of chronic conditions and cancer patients excluded (n = 87,314). Results: Hazard ratios for mortality increased both in Group 3 where it was 2.66 (95% CI 2.25–3.09) and in Group 4 where it was 5.12 (95% CI 4.25–6.17), with increased dose and higher number of chronic conditions. In Group 4 an opioid dose-dependent increase in mortality among persons using >1000 DDDs benzodiazepines/Z-drugs was observed when those on less than ≤300 DDDs of opioids with HR 4.94 (95% CI 3.54–6.88) were compared to those on >300 DDDs with HR 7.61/95% CI 6.08–9.55). This increase in mortality was not observed among ... |
author2 |
Faculty of Medicine Faculty of Pharmaceutical Sciences |
format |
Article in Journal/Newspaper |
author |
Linnet, Kristjan Thorsteinsdottir, Heidrun Sjofn Sigurdsson, Johann Agust Sigurdsson, Emil Larus Gudmundsson, Larus Steinthor |
author_facet |
Linnet, Kristjan Thorsteinsdottir, Heidrun Sjofn Sigurdsson, Johann Agust Sigurdsson, Emil Larus Gudmundsson, Larus Steinthor |
author_sort |
Linnet, Kristjan |
title |
Co-prescribing of opioids and benzodiazepines/Z-drugs associated with all-cause mortality—A population-based longitudinal study in primary care with weak opioids most commonly prescribed |
title_short |
Co-prescribing of opioids and benzodiazepines/Z-drugs associated with all-cause mortality—A population-based longitudinal study in primary care with weak opioids most commonly prescribed |
title_full |
Co-prescribing of opioids and benzodiazepines/Z-drugs associated with all-cause mortality—A population-based longitudinal study in primary care with weak opioids most commonly prescribed |
title_fullStr |
Co-prescribing of opioids and benzodiazepines/Z-drugs associated with all-cause mortality—A population-based longitudinal study in primary care with weak opioids most commonly prescribed |
title_full_unstemmed |
Co-prescribing of opioids and benzodiazepines/Z-drugs associated with all-cause mortality—A population-based longitudinal study in primary care with weak opioids most commonly prescribed |
title_sort |
co-prescribing of opioids and benzodiazepines/z-drugs associated with all-cause mortality—a population-based longitudinal study in primary care with weak opioids most commonly prescribed |
publishDate |
2022 |
url |
https://hdl.handle.net/20.500.11815/3795 https://doi.org/10.3389/fphar.2022.932380 |
genre |
Iceland |
genre_facet |
Iceland |
op_relation |
Frontiers in Pharmacology; 13() http://www.scopus.com/inward/record.url?scp=85138392125&partnerID=8YFLogxK Linnet , K , Thorsteinsdottir , H S , Sigurdsson , J A , Sigurdsson , E L & Gudmundsson , L S 2022 , ' Co-prescribing of opioids and benzodiazepines/Z-drugs associated with all-cause mortality—A population-based longitudinal study in primary care with weak opioids most commonly prescribed ' , Frontiers in Pharmacology , vol. 13 , 932380 , pp. 932380 . https://doi.org/10.3389/fphar.2022.932380 1663-9812 64937790 94885ac9-9c7a-4e7c-9f8c-b6ec6f50cf32 85138392125 36147347 https://hdl.handle.net/20.500.11815/3795 doi:10.3389/fphar.2022.932380 |
op_rights |
info:eu-repo/semantics/openAccess |
op_doi |
https://doi.org/20.500.11815/379510.3389/fphar.2022.932380 |
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Frontiers in Pharmacology |
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1782335971204792320 |