May 7, 2019

Negative Impacts of Combining Antidepressants with Opioids and Benzodiazepines

The Journal of Occupational and Environmental Medicine recently published Association of Opioid, Anti-depressant, and Benzodiazepines with Workers’ Compensation: A Cohort Study, which looks at 22,383 indemnity claims from 2008-2013 to evaluate the association of prescribed medications on claim cost and delayed claim closure.

Controlled for age, chronic pain, and other factors, the study found that the concurrent treatment of pain, depression or anxiety and occupational injuries are associated with large increases in claim costs and delayed return to work. These increases are specifically associated with the combination of antidepressants with opioids, or antidepressants with opioids and benzodiazepines.

According to the study, having antidepressants in a claim makes the claim 2.24x more likely to remain open, while having opioids in a claim leaves the claim 1.14x more likely to remain open, and benzodiazepines leaves a claim 1.38x more likely to remain open.

Claims without any of these medications had the highest closure rate of 91.8% with the lowest average claim cost of $19,604. However, the following drug regimens had lower closure rates and higher average costs:

  • Opioids had an 89.1% closure rate with an average claim cost of $28,563
  • Opioids and benzodiazepines had a 75.8% closure rate with an average claim cost of $53,366
  • Antidepressants and opioids had a 64.8% closure rate with an average claim cost of $64,507
  • Antidepressants, opioids, and benzodiazepines had the lowest closure rate at 58.3%, with the highest average claim cost at $93,367

While antidepressants appear to be linked to higher costs and lower closure rates, it is important to note that this study only looks at antidepressant use in combination with other powerful medications, and not by themselves.

Combining multiple drugs, known as polypharmacy, can often lead to increased risks due to drug-drug interactions, therapeutic duplication, and other concerns, especially when opioids and other powerful medications are involved.

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