Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: Conditional effect of age

Cordovilla‐Guardia, Sergio; Molina, Tania Bautista; Franco‐Antonio, Cristina; Santano‐Mogena, Esperanza; Vilar-López, Raquel

doi:10.1371/journal.pone.0227696

Cited by 10 publications

(4 citation statements)

References 41 publications

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“…In our study, the overall consumption of substances was higher in men than in women, a finding consistent with reported studies [ 25 , 28 - 29 ]. However, as stated above, compared to other studies, both prevalence and pattern of substance use were considerably different in our study population, pointing to historical, geographical and locality-based variations.…”

Section: Discussionsupporting

confidence: 93%

“…It seems surprising, particularly because, unlike opioid consumption, alcohol consumption is more common and is considered a norm on certain occasions. Given the high prevalence of drug abuse, it is important to explore a possible association between benzodiazepines, opioids, and tricyclic antidepressants and trauma due to their increased medical consumption [ 28 , 30 - 31 ]. In our study, benzodiazepines were the second most common drug found after opiates, which supports the growing trend of the consumption of these drugs, with or without a prescription.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Substance Abuse Among Trauma Patients in Rural West Virginia

Mansoor¹,

Goncalves²,

Lakhani³

et al. 2023

Cureus

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Background: Substance abuse poses considerable clinical, economic, and social challenges. West Virginia is hailed as the epicenter of the substance abuse in the United States, the prevalence and pattern of different trauma mechanisms in a rural context or in patients with different forms of substance abuse remain unclear.Objective: We performed the following analysis to understand the prevalence of substance abuse in patients with different trauma mechanisms in the rural setting with high substance abuse in the West Virginia.Methods: We performed a cross-sectional retrospective analysis of adult trauma patients (motor vehicle, fall, assault, firearm suicide, brawl/rape and machinery) hospitalized in two tertiary care hospitals in West Virginia between 2006 and 2016. We identified all patients who had a urine drug screen (UDS) test and extracted the data related to the substance and trauma.Results: Among 8734 patients screened using UDS, 5940 (68.1%) patients were tested positive for the substance. Opiates, alcohol, benzodiazepines, and cannabis were the four most common substances identified in trauma victims. In all instances, the prescribed drug was less than 20%. Fatal outcome was observed in 366 patients in the sample, with 44% (n=162) testing positive for UDS, 12% (n=45) testing positive for only alcohol, and 15% (n=56) testing positive for both alcohol and UDS. Regarding the trauma mechanism, the motor vehicle accident (MVA) was the most prominent with a clear association of substance abuse with fatal outcome. Conclusion:The most prevalent trauma mechanism was a MVA, with a strong link between drug usage and mortality. Due to the high incidence of positive substance abuse screens, UDS tests may need to be more widely implemented in trauma in the West Virginia region. The findings of this study might help in establishing regional or national policies to reduce acute substance abuse.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Prevalence of Substance Abuse Among Trauma Patients in Rural West Virginia

Mansoor¹,

Goncalves²,

Lakhani³

et al. 2023

Cureus

View full text Add to dashboard Cite

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“…These side effects usually abate within 2-3 h as a result of the short duration of action of the drug, minimizing daytime impairment. However, at doses of 60 mg, psychomotor impairment persists for 25 h. in addition to potential side effects of all benzodiazepines and z-drugs that are discussed in detail in this section, adverse effects of specific benzodiazepines that have been variably reported are summarized in Table 2 [33][34][35][36].…”

Section: Adverse Effectsmentioning

confidence: 99%

Benzodiazepines Remain Important Therapeutic Options in Psychiatric Practice

Dubovsky

Marshall

2022

Psychother Psychosom

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Benzodiazepines and medications acting on benzodiazepine receptors that do not have a benzodiazepine structure (z-drugs) have been viewed by some experts and regulatory bodies as having limited benefit and significant risks. Data presented in this article support the use of these medications as treatments of choice for acute situational anxiety, chronic anxiety disorders, insomnia, alcohol withdrawal syndromes, and catatonia. They may also be useful adjuncts in the treatment of anxious depression and mania, and for medically ill patients. Tolerance develops to sedation and possibly psychomotor impairment, but not to the anxiolytic effect of benzodiazepines. Sedation can impair cognitive function in some patients, but assertions that benzodiazepines increase the risk of dementia are not supported by recent data. Contrary to popular opinion, benzodiazepines are not frequently misused or conduits to misuse of other substances in patients without substance use disorders who are prescribed these medications for appropriate indications; most benzodiazepine misuse involves medications that are obtained from other people. Benzodiazepines are usually not lethal in overdose except when ingested with other substances, especially alcohol and opioids. Benzodiazepines comprise one of the few classes of psychotropic medication the mechanisms of action of which are clearly delineated, allowing for greater precision in their clinical use. These medications, therefore, belong in the therapeutic armamentarium of the knowledgeable clinician.

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“…Silverman., et al [38] who assessed the frequency, as well as the treatment characteristics, and risk factors associated with falls or fractures among patients with osteoarthritis taking opioids found falls and fractures impose a major clinical burden on patients if used to a chronic extent for osteoarthritis-related pain management. This may be due to both cognitive as well as gait related modifications and should be examined further [39] especially to identify age associated impacts as related to falls and subsequent pain [40]. As per Taqi., et al [41] who noted analgesics are consistently associated with an increased risk of falls within one year of knee joint osteoarthritis diagnosis, those who use analgesics should be targeted for fall prevention programs/interventions as early as possible.…”

Section: Resultsmentioning

confidence: 99%

Knee Osteoarthritis, Falls, and Opioids: Interactions and Recommendations

Marks

2024

Act Scie Pharma

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Knee osteoarthritis, a widespread highly painful disabling joint disease is increasingly shown to affect and/or be impacted by an increased falls and injury risk. This brief highlights the current research being published as regards the use of narcotic agents to quell pain in this respect and their possible adverse falls associated implications. To this end, PUBMED and other data base indices were selected to identify information specifically pertaining to the topic using the key words: Falls, Fall Injuries, Knee Osteoarthritis, Opioids, and Pain. Results show a reasonable body of current science based evidence implying opioids should be advocated and used sparingly by older adults with knee osteoarthritis who have fallen or are at risk for falling. Conversely, a failure to identify this risk and a role for other methods of pain relief and mitigation may be expected to produce less than optimal clinical results at best.

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Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: Conditional effect of age

Abstract: The association between the consumption of benzodiazepines, opioids and tricyclic antidepressants and falls in patients admitted for trauma is conditioned by other confounding variables, with age being the most influential confounding variable.

Cited by 10 publications

References 41 publications

Prevalence of Substance Abuse Among Trauma Patients in Rural West Virginia

Prevalence of Substance Abuse Among Trauma Patients in Rural West Virginia

Benzodiazepines Remain Important Therapeutic Options in Psychiatric Practice

Knee Osteoarthritis, Falls, and Opioids: Interactions and Recommendations

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