Mixing alcohol with opioids, benzodiazepines sending users to emergency departments

Nearly one-fifth of opioid abuse-related ED visits and more than one-fourth of benzodiazepine abuse-related ED visits involved alcohol, a study found.

To estimate national ED visits, researchers conducted a stratified, simple random sample of 237 nonfederal, short-stay, general hospitals that operated 24-hour EDs and that treated patients who had visits that involved alcohol and opioids or alcohol and benzodiazepines, whether alone or in combination with other drugs. ED visits involving more than 1 type of drug were counted in multiple categories. Results appeared in the Oct. 10 MMWR.

There were 438,718 ED visits related to opioid abuse and 408,021 ED visits related to benzodiazepine abuse, alone or in combination with other drugs, in 2010. Of the opioid ED visits, an estimated 81,365 (18.5%) involved alcohol; of the benzodiazepine ED visits, 111,165 (27.2%) involved alcohol.

Of the 3,883 opioid deaths in 2010, 860 (22.1%) involved alcohol. For benzodiazepines, 324 (21.4%) of the 1,512 deaths involved alcohol. Among single-drug class deaths, 393 (26.1%) opioid and 44 (72.1%) benzodiazepine deaths involved alcohol. Opioids stronger than hydrocodone, such as fentanyl, methadone, and hydromorphone, tended to have less alcohol involvement for both ED visits and deaths.

ED visits that involved opioids and alcohol were highest among patients ages 30 to 44 years (20.6%) and 45 to 54 years (20.0%). For benzodiazepine ED visits, the percentage was highest among patients ages 45 to 54 years (31.1%). Among opioid deaths, patients ages 40 to 49 years (25.2%) and 50 to 59 years (25.3%) had the highest percentage of alcohol involvement. For benzodiazepine-related deaths, the highest percentage (27.7%) was among persons aged ≥60 years.

ED visits involving alcohol and opioids were significantly more common among men than women: 22.9% (95% CI, 18.7% to 27.7%) versus 13.5% (95% CI, 11.1% to 16.4%). The same was true for ED visits involving alcohol and benzodiazepines: 30.6% (95% CI, 26.7% to 34.8%) for men compared to 24.1% (95% CI, 19.6% to 29.2%) for women. Researchers noted that men report higher prevalence, frequency, and intensity of binge drinking compared with women, which might have contributed to the higher percentage of alcohol involvement in ED visits among men.

That one-fifth of opioid drug abuse-related ED visits and drug-related deaths involve alcohol suggests the need for stronger prevention measures, the authors wrote. But the lack of discussion about alcohol consumption overall—only 16% of adults in the United States have discussed alcohol consumption with a health professional—confounds patient communication.

The authors wrote, “Interventions such as combined prevention programs that target alcohol and prescription drug abuse, systematic provider and patient education, and integration of screening and intervention services into the primary care health system to enable early identification of problematic alcohol and drug use might reduce the number of ED visits and deaths related to drug abuse and alcohol.”