Impact of Pharmacist-Led Risk Mitigation Strategies for Veterans Prescribed Concurrent Benzodiazepine and Opioid Medications with or Without a Stimulant.

Abstract

Introduction: Concurrent use of benzodiazepines (BZDs) and opioids increases the risk of overdose by 3-4 times compared to opioids alone. In 2016, boxed warnings and medication guides were added to these medications to highlight the risks of sedation, respiratory depression, coma, and death. Stimulants oppose the central nervous system effects of these agents; thus masking sedation and can lead to potential unintentional overdose. With this knowledge, the objective of this study was to enhance risk mitigation interventions in patients prescribed BZD and opioids with or without stimulants.

Methods: This single-center, prospective quality-improvement study evaluated patient engagement in pharmacist-led comprehensive medication management (CMM) to reduce risks associated with concurrent BZD and opioid use (+/- stimulants). The secondary outcome assessed the willingness of patients to initiate tapers. Patients were identified utilizing the Psychotropic Drug Safety Initiative Dashboard (PDSI) from December 17, 2024 to February 4, 2025, and contacted for CMM via phone calls.

Results: Among 43 patients, 95% (n = 41) agreed to pharmacist-led CMM. Naloxone was ordered for 70% (n = 30) of patients. Additionally, 4 patients agreed to meet with a clinical pharmacy practitioner to discuss tapering.

Conclusion: Pharmacist-led CMM and tailored education effectively encourage patient engagement and openness to medication tapers. Continued efforts are needed to reduce concurrent prescribing of BZDs and opioids.