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Opioid Safety and Concomitant Benzodiazepine Use in End-Stage Renal Disease Patients

BACKGROUND: Opioid use is common in end-stage renal disease (ESRD) patients. However, safety of individual opioids and concomitant benzodiazepine use has not been studied. OBJECTIVE: To study the epidemiology of opioid and concomitant benzodiazepine use in ESRD population. To study the clinical safe...

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Autores principales: Ruchi, Rupam, Bozorgmehri, Shahab, Ozrazgat-Baslanti, Tezcan, Segal, Mark S, Shukla, Ashutosh M, Mohandas, Rajesh, Kumar, Sanjeev
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854236/
https://www.ncbi.nlm.nih.gov/pubmed/31772694
http://dx.doi.org/10.1155/2019/3865924
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author Ruchi, Rupam
Bozorgmehri, Shahab
Ozrazgat-Baslanti, Tezcan
Segal, Mark S
Shukla, Ashutosh M
Mohandas, Rajesh
Kumar, Sanjeev
author_facet Ruchi, Rupam
Bozorgmehri, Shahab
Ozrazgat-Baslanti, Tezcan
Segal, Mark S
Shukla, Ashutosh M
Mohandas, Rajesh
Kumar, Sanjeev
author_sort Ruchi, Rupam
collection PubMed
description BACKGROUND: Opioid use is common in end-stage renal disease (ESRD) patients. However, safety of individual opioids and concomitant benzodiazepine use has not been studied. OBJECTIVE: To study the epidemiology of opioid and concomitant benzodiazepine use in ESRD population. To study the clinical safety profile of individual opioids in patients on hemodialysis. DESIGN: Retrospective analysis of the U.S. Renal Data System. A comprehensive review of the current literature was performed to update currently used opioid safety classification. PARTICIPANTS: ESRD patients ≥18 years on hemodialysis who were enrolled in Medicare A and B and Part D between 2006 and 2012, excluding those with malignancy. MAIN MEASURES: Hospital admission with diagnosis of prescription opioid overdose within 30, 60, and 90 days of prescription; death due to opioid overdose. RESULTS: Annually, the percentage of patients prescribed any opioid was 52.2%. Overall trend has been increasing except for a small dip in 2011, despite which the admissions due to opioid overdose have been rising. 30% of those who got a prescription for opioids also got a benzodiazepine prescription. 56.5% of these patients received both prescriptions within a week of each other. Benzodiazepine use increased the odds of being on opioids by 3.27 (CI 3.21–3.32) and increased the odds of hospitalization by 50%. Opioids considered safe such as fentanyl and methadone were associated with 3 and 6 folds higher odds of hospitalization within 30 days of prescription. Hydrocodone had the lowest odds ratio (1.9, CI 1.8–2.0). CONCLUSIONS: Concurrent benzodiazepine use is common and associated with higher risk of hospitalization due to opioid overdose. Possible opioid-associated hospital admission rate is 4-5 times bigger in ESRD population than general population. Current safety classification of opioids in these patients is misleading, and even drugs considered safe based on pharmacokinetic data are associated with moderate to very high risk of hospitalization. We propose a risk-stratified classification of opioids and suggest starting to use them in all ESRD patients.
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spelling pubmed-68542362019-11-26 Opioid Safety and Concomitant Benzodiazepine Use in End-Stage Renal Disease Patients Ruchi, Rupam Bozorgmehri, Shahab Ozrazgat-Baslanti, Tezcan Segal, Mark S Shukla, Ashutosh M Mohandas, Rajesh Kumar, Sanjeev Pain Res Manag Research Article BACKGROUND: Opioid use is common in end-stage renal disease (ESRD) patients. However, safety of individual opioids and concomitant benzodiazepine use has not been studied. OBJECTIVE: To study the epidemiology of opioid and concomitant benzodiazepine use in ESRD population. To study the clinical safety profile of individual opioids in patients on hemodialysis. DESIGN: Retrospective analysis of the U.S. Renal Data System. A comprehensive review of the current literature was performed to update currently used opioid safety classification. PARTICIPANTS: ESRD patients ≥18 years on hemodialysis who were enrolled in Medicare A and B and Part D between 2006 and 2012, excluding those with malignancy. MAIN MEASURES: Hospital admission with diagnosis of prescription opioid overdose within 30, 60, and 90 days of prescription; death due to opioid overdose. RESULTS: Annually, the percentage of patients prescribed any opioid was 52.2%. Overall trend has been increasing except for a small dip in 2011, despite which the admissions due to opioid overdose have been rising. 30% of those who got a prescription for opioids also got a benzodiazepine prescription. 56.5% of these patients received both prescriptions within a week of each other. Benzodiazepine use increased the odds of being on opioids by 3.27 (CI 3.21–3.32) and increased the odds of hospitalization by 50%. Opioids considered safe such as fentanyl and methadone were associated with 3 and 6 folds higher odds of hospitalization within 30 days of prescription. Hydrocodone had the lowest odds ratio (1.9, CI 1.8–2.0). CONCLUSIONS: Concurrent benzodiazepine use is common and associated with higher risk of hospitalization due to opioid overdose. Possible opioid-associated hospital admission rate is 4-5 times bigger in ESRD population than general population. Current safety classification of opioids in these patients is misleading, and even drugs considered safe based on pharmacokinetic data are associated with moderate to very high risk of hospitalization. We propose a risk-stratified classification of opioids and suggest starting to use them in all ESRD patients. Hindawi 2019-10-20 /pmc/articles/PMC6854236/ /pubmed/31772694 http://dx.doi.org/10.1155/2019/3865924 Text en Copyright © 2019 Rupam Ruchi et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Ruchi, Rupam
Bozorgmehri, Shahab
Ozrazgat-Baslanti, Tezcan
Segal, Mark S
Shukla, Ashutosh M
Mohandas, Rajesh
Kumar, Sanjeev
Opioid Safety and Concomitant Benzodiazepine Use in End-Stage Renal Disease Patients
title Opioid Safety and Concomitant Benzodiazepine Use in End-Stage Renal Disease Patients
title_full Opioid Safety and Concomitant Benzodiazepine Use in End-Stage Renal Disease Patients
title_fullStr Opioid Safety and Concomitant Benzodiazepine Use in End-Stage Renal Disease Patients
title_full_unstemmed Opioid Safety and Concomitant Benzodiazepine Use in End-Stage Renal Disease Patients
title_short Opioid Safety and Concomitant Benzodiazepine Use in End-Stage Renal Disease Patients
title_sort opioid safety and concomitant benzodiazepine use in end-stage renal disease patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854236/
https://www.ncbi.nlm.nih.gov/pubmed/31772694
http://dx.doi.org/10.1155/2019/3865924
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