{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T23:22:35Z","timestamp":1788996155734,"version":"build-2803163510"},"reference-count":39,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,8,20]]},"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The objective of this study is to characterise concurrent use of benzodiazepine receptor modulators and opioids among prescription opioid users in Alberta in 2017.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A population based retrospective study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Alberta, Canada, in the year 2017.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>All individuals in Alberta, Canada, with at least one dispensation record from a community pharmacy for an opioid in the year 2017.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Exposure<\/jats:title>\n                  <jats:p>Concurrent use of a benzodiazepine receptor modulator and opioid, defined as overlap of supply for both drugs for at least 1\u2009day.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Prevalence of concurrency was estimated among subgroups of patient characteristics that were considered clinically relevant or associated with inappropriate medication use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among the 547\u2009709 Albertans who were dispensed opioid prescriptions in 2017, 132\u2009156 (24%) also received prescriptions for benzodiazepine receptor modulators. There were 96\u2009581 (17.6%) prescription opioid users who concurrently used benzodiazepine receptor modulators with an average of 98 days (SD=114, 95%\u2009CI 97 to 99) of total cumulative concurrency and a median of 37 days (IQR 10 to 171). The average longest duration of consecutive days of concurrency was 45 (SD=60, 95%\u2009CI 44.6 to 45.4) with a median of 24 days (IQR 8 to 59). Concurrency was more prevalent in females, patients using an average daily oral morphine equivalent &gt;90\u2009mg, opioid dependence therapy patients, chronic opioid users, patients utilising a high number of unique providers, lower median household incomes and those older than 65 (p value&lt;0.001 for all comparisons).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Concurrent prescribing of opioids and benzodiazepine receptor modulators is common in Alberta despite the ongoing guidance of many clinical resources. Older patients, those taking higher doses of opioids, and for longer durations may be at particular risk of adverse outcomes and may be worthy of closer follow-up for assessment for dose tapering or discontinuations. As well, those with higher healthcare utilisation (seeking multiple providers) should also be closely monitored. Continued surveillance of concurrent use of these medications is warranted to ensure that safe drug use recommendations are being followed by health providers.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-030858","type":"journal-article","created":{"date-parts":[[2019,9,7]],"date-time":"2019-09-07T07:25:27Z","timestamp":1567841127000},"page":"e030858","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["Characterisation of concurrent use of prescription opioids and benzodiazepine\/Z-drugs in Alberta, Canada: a population-based study"],"prefix":"10.1136","volume":"9","author":[{"given":"Vishal","family":"Sharma","sequence":"first","affiliation":[{"name":"School of Public Health, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniala","family":"Weir","sequence":"additional","affiliation":[{"name":"McGill Clinical and Health Informatics, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim","family":"Samanani","sequence":"additional","affiliation":[{"name":"Okaki Health Intelligence, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scot H","family":"Simpson","sequence":"additional","affiliation":[{"name":"Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fizza","family":"Gilani","sequence":"additional","affiliation":[{"name":"The College of Physicians & Surgeons of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ed","family":"Jess","sequence":"additional","affiliation":[{"name":"The College of Physicians & Surgeons of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean T","family":"Eurich","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,9,6]]},"reference":[{"key":"2025101813002875000_9.9.e030858.1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.170363"},{"key":"2025101813002875000_9.9.e030858.2","doi-asserted-by":"crossref","first-page":"256","DOI":"10.24095\/hpcdp.38.6.07","article-title":"Evaluating the early impacts of delisting high-strength opioids on patterns of prescribing in Ontario","volume":"38","author":"Guan","year":"2018","journal-title":"Health Promot Chronic Dis Prev Can"},{"key":"2025101813002875000_9.9.e030858.3","doi-asserted-by":"crossref","first-page":"224","DOI":"10.24095\/hpcdp.38.6.02","article-title":"Evidence synthesis - The opioid crisis in Canada: a national perspective","volume":"38","author":"Belzak","year":"2018","journal-title":"Health Promotion and Chronic Disease Prevention in Canada"},{"key":"2025101813002875000_9.9.e030858.4","doi-asserted-by":"crossref","first-page":"244","DOI":"10.24095\/hpcdp.38.6.04","article-title":"At-a-glance - Hospitalizations and emergency department visits due to opioid poisoning in Canada","volume":"38","author":"O'Connor","year":"2018","journal-title":"Health Promot Chronic Dis Prev Can"},{"key":"2025101813002875000_9.9.e030858.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.coph.2005.10.003"},{"issue":"Suppl 2","key":"2025101813002875000_9.9.e030858.6","first-page":"14","article-title":"The GABA-benzodiazepine receptor complex: structure, function, and role in anxiety","volume":"66","author":"Roy-Byrne","year":"2005","journal-title":"J Clin Psychiatry"},{"key":"2025101813002875000_9.9.e030858.7","unstructured":"CPSA . 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