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Benzodiazepine dosing schedule was not associated with risk of death from drug overdose.Conclusions Among veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of death from drug overdose in a dose response fashion.IntroductionDeaths from drug overdose, particularly involving opioid analgesics, have increased steadily over the past two decades and are now one of the leading causes of mortality from injury in the United States.1 Of the deaths from overdose related to pharmaceuticals, which constituted 58% of total deaths from drug overdose in 2010, 75% involved opioid analgesics.2 Thirty percent of overdose deaths related to opioid analgesics involved benzodiazepines, drugs commonly prescribed concurrently for patients who receive opioid analgesics.3 4 5 Although the toxicity of benzodiazepines used in isolation is generally considered mild in young and middle aged adults, the risks from oversedation are believed to be magnified when they are combined with other substances with sedating properties, such as opioids.6 7 Also, receipt of benzodiazepines could be a marker of the presence of a severe anxiety disorder, which carries its own risk for death from intentional and unintentional overdose.8 9Trends in deaths from overdose have been connected to patterns of opioid prescribing, an increasingly common treatment for pain.10 On a population level, increasing rates of opioid prescribing have been linked to an increased rate of death from overdose11; on an individual level, the risk of death from overdose is higher among those receiving higher doses of opioids.12 13 One study generated the hypothesis that receipt of benzodiazepines might be associated with increased risk of death from overdose in patients receiving opioid analgesics.13 To our knowledge, no large nationwide study has focused on death from drug overdose and receipt of benzodiazepines and their prescribing patterns, such as the daily benzodiazepine dose, the type of benzodiazepine prescribed, or the dosing schedule of the prescription, among those receiving opioids for pain.We investigated the relation between the receipt of concurrent benzodiazepines and opioid analgesics and death from drug overdose in patients receiving prescription opioids for the treatment of acute or chronic pain and pain associated with cancer. Quantification of the magnitude of risk associated with these patterns might help to identify individuals at particularly high risk for death from drug overdose and could potentially inform risk reduction approaches in this population. We hypothesized that receipt of concurrent benzodiazepines and opioid analgesics would be associated with death from drug overdose and that this association would be dose dependent and vary by type of benzodiazepine and dosing schedule.
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Lerner, the IRS's former director of Exempt Organizations, is the key figure in the controversy over how the agency treated conservative groups seeking tax exemptions. Hotel Taj Mahal Palace This iconic landmark of Mumbai is located in the Apollo Bunder near the Gateway of India.
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