Abstract
An important predictor of opioid overdose is co-use of benzodiazepines, which are
often prescribed for anxiety. Coping with anxiety may be particularly difficult among
individuals with a history of abuse, as it is often linked to higher pain severity
and poorer coping skills. We explored whether abuse history moderated the association
between anxiety and benzodiazepine use among current opioid users. New patients at
a tertiary care, outpatient pain clinic completed self-report measures of medication
use, anxiety, and physical and sexual abuse history (child abuse only, adult abuse
only, or cumulative abuse). The present study included adult patients reporting current
opioid use (n = 1,785). Approximately 16% reported co-use of benzodiazepines, and
17% reported a history of abuse. Patients reporting child abuse only and cumulative
abuse reported co-use of benzodiazepines and opioids more often than those denying
abuse and patients reporting adult abuse only (P < .001). Multivariate logistic regression analyses showed that the probability of
benzodiazepine use among patients reporting cumulative abuse increased sharply at
high levels of anxiety (P = .003). Cumulative abuse may increase sensitivity to psychological distress and
put patients at risk for co-use. Providers should be aware of life history factors,
including abuse, that may drive the need for medication.
Perspective: This article examines the association between history of abuse victimization
and co-use of benzodiazepines among chronic pain patients reporting current opioid
use. The findings suggest that cumulative victimization across the lifespan may contribute
to co-use by increasing sensitivity to psychological or physical distress or by negatively
impacting coping skills.
Key words
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Article info
Publication history
Published online: November 16, 2018
Accepted:
October 30,
2018
Received in revised form:
October 24,
2018
Received:
July 14,
2018
Footnotes
Supported by the Department of Anesthesiology, University of Michigan, Ann Arbor, MI.
J.P., S.M., and J.A.C. have no disclosures. J.G. is supported by a career development grant from the National Institute on Drug Abuse (K23 DA038718). A.L.H. is a consultant for AbbVie Inc. and is supported by a grant from the National Institute of Nursing Research (R01 NR017096), not related to this work. C.M.B. is a consultant for Recro Pharma Inc. and Heron Therapeutics, and is supported by grants from the National Institutes of Health (R01 DA042859-05; R01 HD088712-05; R01 NR017096-05; K23 DA038718-04; R01 DA038261-05; P50 AR070600-05 CORT) and the Michigan Department of Health and Human Services, not related to this work.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2018 by the American Pain Society
