Hieu-Pham/cpgQA huggingface dataset:
Recommendations

There is a large variation in patient preference regarding the concurrent use of benzodiazepines and LOT.  This is especially true for patients who are already accustomed to receiving both medications (see Patient  Focus Group Methods and Findings). Concurrent benzodiazepine and LOT use is a serious risk factor for  unintentional overdose death and should be weighed heavily in the risk-benefit evaluation for tapering  versus continuing one or both agents. Once initiated, benzodiazepines can be challenging to discontinue due to symptoms related to benzodiazepine dependence, exacerbations of PTSD, and/or anxiety.[91]  Moreover, abrupt discontinuation of benzodiazepines should be avoided, as it can lead to serious adverse  effects including seizures and death. Tapering benzodiazepines should be performed with caution and  within a team environment when possible (see Recommendation 26 in the VA/DoD SUD CPG).7 Due to the  difficulty of tapering or discontinuing benzodiazepines, particular caution should be used when considering initiating benzodiazepines for Veterans with PTSD who have co-occurring chronic pain. The VA/DoD PTSD  CPG recommends against benzodiazepines for the prevention of PTSD and cautions against their use in  treatment of PTSD. Benzodiazepines to treat acute anxiety symptoms after trauma are associated with a  higher incidence of PTSD symptoms. For treatment of PTSD, there is evidence of lack of efficacy from small  clinical trials and evidence of harm from observational studies of benzodiazepines for PTSD. Although  anxiety may initially improve with benzodiazepines, the improvement is short-lived and may result in  tolerance to increasing doses and eventual failure of the treatment. Even gradual benzodiazepine taper  may result in exacerbation of severe PTSD symptoms. Concomitant use of benzodiazepines is considered a  contraindication to initiation of OT.  

Question: For whom particular caution should be used when considering initiating benzodiazepines due to the difficulty of tapering or discontinuing benzodiazepines?
Answer: Veterans with PTSD who have co-occurring chronic pain
Recommendations

There is a large variation in patient preference regarding the concurrent use of benzodiazepines and LOT.  This is especially true for patients who are already accustomed to receiving both medications (see Patient  Focus Group Methods and Findings). Concurrent benzodiazepine and LOT use is a serious risk factor for  unintentional overdose death and should be weighed heavily in the risk-benefit evaluation for tapering  versus continuing one or both agents. Once initiated, benzodiazepines can be challenging to discontinue due to symptoms related to benzodiazepine dependence, exacerbations of PTSD, and/or anxiety.[91]  Moreover, abrupt discontinuation of benzodiazepines should be avoided, as it can lead to serious adverse  effects including seizures and death. Tapering benzodiazepines should be performed with caution and  within a team environment when possible (see Recommendation 26 in the VA/DoD SUD CPG).7 Due to the  difficulty of tapering or discontinuing benzodiazepines, particular caution should be used when considering initiating benzodiazepines for Veterans with PTSD who have co-occurring chronic pain. The VA/DoD PTSD  CPG recommends against benzodiazepines for the prevention of PTSD and cautions against their use in  treatment of PTSD. Benzodiazepines to treat acute anxiety symptoms after trauma are associated with a  higher incidence of PTSD symptoms. For treatment of PTSD, there is evidence of lack of efficacy from small  clinical trials and evidence of harm from observational studies of benzodiazepines for PTSD. Although  anxiety may initially improve with benzodiazepines, the improvement is short-lived and may result in  tolerance to increasing doses and eventual failure of the treatment. Even gradual benzodiazepine taper  may result in exacerbation of severe PTSD symptoms. Concomitant use of benzodiazepines is considered a  contraindication to initiation of OT.  

Question: What does recommend against benzodiazepines for the prevention of PTSD?
Answer: The VA/DoD PTSD  CPG
Recommendations

There is a large variation in patient preference regarding the concurrent use of benzodiazepines and LOT.  This is especially true for patients who are already accustomed to receiving both medications (see Patient  Focus Group Methods and Findings). Concurrent benzodiazepine and LOT use is a serious risk factor for  unintentional overdose death and should be weighed heavily in the risk-benefit evaluation for tapering  versus continuing one or both agents. Once initiated, benzodiazepines can be challenging to discontinue due to symptoms related to benzodiazepine dependence, exacerbations of PTSD, and/or anxiety.[91]  Moreover, abrupt discontinuation of benzodiazepines should be avoided, as it can lead to serious adverse  effects including seizures and death. Tapering benzodiazepines should be performed with caution and  within a team environment when possible (see Recommendation 26 in the VA/DoD SUD CPG).7 Due to the  difficulty of tapering or discontinuing benzodiazepines, particular caution should be used when considering initiating benzodiazepines for Veterans with PTSD who have co-occurring chronic pain. The VA/DoD PTSD  CPG recommends against benzodiazepines for the prevention of PTSD and cautions against their use in  treatment of PTSD. Benzodiazepines to treat acute anxiety symptoms after trauma are associated with a  higher incidence of PTSD symptoms. For treatment of PTSD, there is evidence of lack of efficacy from small  clinical trials and evidence of harm from observational studies of benzodiazepines for PTSD. Although  anxiety may initially improve with benzodiazepines, the improvement is short-lived and may result in  tolerance to increasing doses and eventual failure of the treatment. Even gradual benzodiazepine taper  may result in exacerbation of severe PTSD symptoms. Concomitant use of benzodiazepines is considered a  contraindication to initiation of OT.  

Question: What is the stance regarding the use of benzodiazepines for the prevention of PTSD?
Answer: recommends against
Recommendations

There is a large variation in patient preference regarding the concurrent use of benzodiazepines and LOT.  This is especially true for patients who are already accustomed to receiving both medications (see Patient  Focus Group Methods and Findings). Concurrent benzodiazepine and LOT use is a serious risk factor for  unintentional overdose death and should be weighed heavily in the risk-benefit evaluation for tapering  versus continuing one or both agents. Once initiated, benzodiazepines can be challenging to discontinue due to symptoms related to benzodiazepine dependence, exacerbations of PTSD, and/or anxiety.[91]  Moreover, abrupt discontinuation of benzodiazepines should be avoided, as it can lead to serious adverse  effects including seizures and death. Tapering benzodiazepines should be performed with caution and  within a team environment when possible (see Recommendation 26 in the VA/DoD SUD CPG).7 Due to the  difficulty of tapering or discontinuing benzodiazepines, particular caution should be used when considering initiating benzodiazepines for Veterans with PTSD who have co-occurring chronic pain. The VA/DoD PTSD  CPG recommends against benzodiazepines for the prevention of PTSD and cautions against their use in  treatment of PTSD. Benzodiazepines to treat acute anxiety symptoms after trauma are associated with a  higher incidence of PTSD symptoms. For treatment of PTSD, there is evidence of lack of efficacy from small  clinical trials and evidence of harm from observational studies of benzodiazepines for PTSD. Although  anxiety may initially improve with benzodiazepines, the improvement is short-lived and may result in  tolerance to increasing doses and eventual failure of the treatment. Even gradual benzodiazepine taper  may result in exacerbation of severe PTSD symptoms. Concomitant use of benzodiazepines is considered a  contraindication to initiation of OT.  

Question: What does caution against the use of benzodiazepines in treatment of PTSD?
Answer: The VA/DoD PTSD  CPG
Recommendations

There is a large variation in patient preference regarding the concurrent use of benzodiazepines and LOT.  This is especially true for patients who are already accustomed to receiving both medications (see Patient  Focus Group Methods and Findings). Concurrent benzodiazepine and LOT use is a serious risk factor for  unintentional overdose death and should be weighed heavily in the risk-benefit evaluation for tapering  versus continuing one or both agents. Once initiated, benzodiazepines can be challenging to discontinue due to symptoms related to benzodiazepine dependence, exacerbations of PTSD, and/or anxiety.[91]  Moreover, abrupt discontinuation of benzodiazepines should be avoided, as it can lead to serious adverse  effects including seizures and death. Tapering benzodiazepines should be performed with caution and  within a team environment when possible (see Recommendation 26 in the VA/DoD SUD CPG).7 Due to the  difficulty of tapering or discontinuing benzodiazepines, particular caution should be used when considering initiating benzodiazepines for Veterans with PTSD who have co-occurring chronic pain. The VA/DoD PTSD  CPG recommends against benzodiazepines for the prevention of PTSD and cautions against their use in  treatment of PTSD. Benzodiazepines to treat acute anxiety symptoms after trauma are associated with a  higher incidence of PTSD symptoms. For treatment of PTSD, there is evidence of lack of efficacy from small  clinical trials and evidence of harm from observational studies of benzodiazepines for PTSD. Although  anxiety may initially improve with benzodiazepines, the improvement is short-lived and may result in  tolerance to increasing doses and eventual failure of the treatment. Even gradual benzodiazepine taper  may result in exacerbation of severe PTSD symptoms. Concomitant use of benzodiazepines is considered a  contraindication to initiation of OT.  

Question: What are associated with a higher incidence of PTSD symptoms?
Answer: Benzodiazepines to treat acute anxiety symptoms after trauma
Recommendations

There is a large variation in patient preference regarding the concurrent use of benzodiazepines and LOT.  This is especially true for patients who are already accustomed to receiving both medications (see Patient  Focus Group Methods and Findings). Concurrent benzodiazepine and LOT use is a serious risk factor for  unintentional overdose death and should be weighed heavily in the risk-benefit evaluation for tapering  versus continuing one or both agents. Once initiated, benzodiazepines can be challenging to discontinue due to symptoms related to benzodiazepine dependence, exacerbations of PTSD, and/or anxiety.[91]  Moreover, abrupt discontinuation of benzodiazepines should be avoided, as it can lead to serious adverse  effects including seizures and death. Tapering benzodiazepines should be performed with caution and  within a team environment when possible (see Recommendation 26 in the VA/DoD SUD CPG).7 Due to the  difficulty of tapering or discontinuing benzodiazepines, particular caution should be used when considering initiating benzodiazepines for Veterans with PTSD who have co-occurring chronic pain. The VA/DoD PTSD  CPG recommends against benzodiazepines for the prevention of PTSD and cautions against their use in  treatment of PTSD. Benzodiazepines to treat acute anxiety symptoms after trauma are associated with a  higher incidence of PTSD symptoms. For treatment of PTSD, there is evidence of lack of efficacy from small  clinical trials and evidence of harm from observational studies of benzodiazepines for PTSD. Although  anxiety may initially improve with benzodiazepines, the improvement is short-lived and may result in  tolerance to increasing doses and eventual failure of the treatment. Even gradual benzodiazepine taper  may result in exacerbation of severe PTSD symptoms. Concomitant use of benzodiazepines is considered a  contraindication to initiation of OT.  

Question: Benzodiazepines to treat acute anxiety symptoms after trauma are associated with what?
Answer: a  higher incidence of PTSD symptoms
Recommendations

There is a large variation in patient preference regarding the concurrent use of benzodiazepines and LOT.  This is especially true for patients who are already accustomed to receiving both medications (see Patient  Focus Group Methods and Findings). Concurrent benzodiazepine and LOT use is a serious risk factor for  unintentional overdose death and should be weighed heavily in the risk-benefit evaluation for tapering  versus continuing one or both agents. Once initiated, benzodiazepines can be challenging to discontinue due to symptoms related to benzodiazepine dependence, exacerbations of PTSD, and/or anxiety.[91]  Moreover, abrupt discontinuation of benzodiazepines should be avoided, as it can lead to serious adverse  effects including seizures and death. Tapering benzodiazepines should be performed with caution and  within a team environment when possible (see Recommendation 26 in the VA/DoD SUD CPG).7 Due to the  difficulty of tapering or discontinuing benzodiazepines, particular caution should be used when considering initiating benzodiazepines for Veterans with PTSD who have co-occurring chronic pain. The VA/DoD PTSD  CPG recommends against benzodiazepines for the prevention of PTSD and cautions against their use in  treatment of PTSD. Benzodiazepines to treat acute anxiety symptoms after trauma are associated with a  higher incidence of PTSD symptoms. For treatment of PTSD, there is evidence of lack of efficacy from small  clinical trials and evidence of harm from observational studies of benzodiazepines for PTSD. Although  anxiety may initially improve with benzodiazepines, the improvement is short-lived and may result in  tolerance to increasing doses and eventual failure of the treatment. Even gradual benzodiazepine taper  may result in exacerbation of severe PTSD symptoms. Concomitant use of benzodiazepines is considered a  contraindication to initiation of OT.  

Question: What is the effect of benzodiazepines in patients with PTSD?
Answer: Although  anxiety may initially improve with benzodiazepines, the improvement is short-lived and may result in  tolerance to increasing doses and eventual failure of the treatment.
Recommendations

There is a large variation in patient preference regarding the concurrent use of benzodiazepines and LOT.  This is especially true for patients who are already accustomed to receiving both medications (see Patient  Focus Group Methods and Findings). Concurrent benzodiazepine and LOT use is a serious risk factor for  unintentional overdose death and should be weighed heavily in the risk-benefit evaluation for tapering  versus continuing one or both agents. Once initiated, benzodiazepines can be challenging to discontinue due to symptoms related to benzodiazepine dependence, exacerbations of PTSD, and/or anxiety.[91]  Moreover, abrupt discontinuation of benzodiazepines should be avoided, as it can lead to serious adverse  effects including seizures and death. Tapering benzodiazepines should be performed with caution and  within a team environment when possible (see Recommendation 26 in the VA/DoD SUD CPG).7 Due to the  difficulty of tapering or discontinuing benzodiazepines, particular caution should be used when considering initiating benzodiazepines for Veterans with PTSD who have co-occurring chronic pain. The VA/DoD PTSD  CPG recommends against benzodiazepines for the prevention of PTSD and cautions against their use in  treatment of PTSD. Benzodiazepines to treat acute anxiety symptoms after trauma are associated with a  higher incidence of PTSD symptoms. For treatment of PTSD, there is evidence of lack of efficacy from small  clinical trials and evidence of harm from observational studies of benzodiazepines for PTSD. Although  anxiety may initially improve with benzodiazepines, the improvement is short-lived and may result in  tolerance to increasing doses and eventual failure of the treatment. Even gradual benzodiazepine taper  may result in exacerbation of severe PTSD symptoms. Concomitant use of benzodiazepines is considered a  contraindication to initiation of OT.  

Question: What may gradual benzodiazepine taper result in?
Answer: exacerbation of severe PTSD symptoms
Recommendations

There is a large variation in patient preference regarding the concurrent use of benzodiazepines and LOT.  This is especially true for patients who are already accustomed to receiving both medications (see Patient  Focus Group Methods and Findings). Concurrent benzodiazepine and LOT use is a serious risk factor for  unintentional overdose death and should be weighed heavily in the risk-benefit evaluation for tapering  versus continuing one or both agents. Once initiated, benzodiazepines can be challenging to discontinue due to symptoms related to benzodiazepine dependence, exacerbations of PTSD, and/or anxiety.[91]  Moreover, abrupt discontinuation of benzodiazepines should be avoided, as it can lead to serious adverse  effects including seizures and death. Tapering benzodiazepines should be performed with caution and  within a team environment when possible (see Recommendation 26 in the VA/DoD SUD CPG).7 Due to the  difficulty of tapering or discontinuing benzodiazepines, particular caution should be used when considering initiating benzodiazepines for Veterans with PTSD who have co-occurring chronic pain. The VA/DoD PTSD  CPG recommends against benzodiazepines for the prevention of PTSD and cautions against their use in  treatment of PTSD. Benzodiazepines to treat acute anxiety symptoms after trauma are associated with a  higher incidence of PTSD symptoms. For treatment of PTSD, there is evidence of lack of efficacy from small  clinical trials and evidence of harm from observational studies of benzodiazepines for PTSD. Although  anxiety may initially improve with benzodiazepines, the improvement is short-lived and may result in  tolerance to increasing doses and eventual failure of the treatment. Even gradual benzodiazepine taper  may result in exacerbation of severe PTSD symptoms. Concomitant use of benzodiazepines is considered a  contraindication to initiation of OT.  

Question: Exacerbation of severe PTSD symptoms may result from what?
Answer: gradual benzodiazepine taper
Recommendations

There is a large variation in patient preference regarding the concurrent use of benzodiazepines and LOT.  This is especially true for patients who are already accustomed to receiving both medications (see Patient  Focus Group Methods and Findings). Concurrent benzodiazepine and LOT use is a serious risk factor for  unintentional overdose death and should be weighed heavily in the risk-benefit evaluation for tapering  versus continuing one or both agents. Once initiated, benzodiazepines can be challenging to discontinue due to symptoms related to benzodiazepine dependence, exacerbations of PTSD, and/or anxiety.[91]  Moreover, abrupt discontinuation of benzodiazepines should be avoided, as it can lead to serious adverse  effects including seizures and death. Tapering benzodiazepines should be performed with caution and  within a team environment when possible (see Recommendation 26 in the VA/DoD SUD CPG).7 Due to the  difficulty of tapering or discontinuing benzodiazepines, particular caution should be used when considering initiating benzodiazepines for Veterans with PTSD who have co-occurring chronic pain. The VA/DoD PTSD  CPG recommends against benzodiazepines for the prevention of PTSD and cautions against their use in  treatment of PTSD. Benzodiazepines to treat acute anxiety symptoms after trauma are associated with a  higher incidence of PTSD symptoms. For treatment of PTSD, there is evidence of lack of efficacy from small  clinical trials and evidence of harm from observational studies of benzodiazepines for PTSD. Although  anxiety may initially improve with benzodiazepines, the improvement is short-lived and may result in  tolerance to increasing doses and eventual failure of the treatment. Even gradual benzodiazepine taper  may result in exacerbation of severe PTSD symptoms. Concomitant use of benzodiazepines is considered a  contraindication to initiation of OT.  

Question: What is considered a contraindication to initiation of OT?
Answer: Concomitant use of benzodiazepines
Recommendations

In addition to benzodiazepines, the addition of other psychoactive medications to LOT must be made with  caution. While the evidence for harm associated with the combination of opioids and Z-drugs (e.g.,  zolpidem, eszopiclone) is not as strong as the evidence for harm associated with the combination of  opioids and benzodiazepines, we suggest not prescribing Z-drugs to patients who are on LOT, as moderate  quality evidence demonstrates that the combination of zolpidem and opioids increases the AOR of  overdose.[66] The evidence reviewed also identifies potential adverse outcomes (e.g., risk of overdose)  with the combined use of antidepressants and opioids in patients who do not have depression.[66] This  particular study did not differentiate between classes of antidepressants, limiting the ability of the Work  Group to recommend for or against prescribing opioids and a specific class of antidepressants. As such,  there is no recommendation in this guideline with respect to using specific classes of antidepressants and  LOT.  

Question: In addition to benzodiazepines, what to do with caution?
Answer: the addition of other psychoactive medications to LOT
Recommendations

In addition to benzodiazepines, the addition of other psychoactive medications to LOT must be made with  caution. While the evidence for harm associated with the combination of opioids and Z-drugs (e.g.,  zolpidem, eszopiclone) is not as strong as the evidence for harm associated with the combination of  opioids and benzodiazepines, we suggest not prescribing Z-drugs to patients who are on LOT, as moderate  quality evidence demonstrates that the combination of zolpidem and opioids increases the AOR of  overdose.[66] The evidence reviewed also identifies potential adverse outcomes (e.g., risk of overdose)  with the combined use of antidepressants and opioids in patients who do not have depression.[66] This  particular study did not differentiate between classes of antidepressants, limiting the ability of the Work  Group to recommend for or against prescribing opioids and a specific class of antidepressants. As such,  there is no recommendation in this guideline with respect to using specific classes of antidepressants and  LOT.  

Question: What is not as strong as the evidence for harm associated with the combination of  opioids and benzodiazepines?
Answer: the evidence for harm associated with the combination of opioids and Z-drugs (e.g.,  zolpidem, eszopiclone)
Recommendations

In addition to benzodiazepines, the addition of other psychoactive medications to LOT must be made with  caution. While the evidence for harm associated with the combination of opioids and Z-drugs (e.g.,  zolpidem, eszopiclone) is not as strong as the evidence for harm associated with the combination of  opioids and benzodiazepines, we suggest not prescribing Z-drugs to patients who are on LOT, as moderate  quality evidence demonstrates that the combination of zolpidem and opioids increases the AOR of  overdose.[66] The evidence reviewed also identifies potential adverse outcomes (e.g., risk of overdose)  with the combined use of antidepressants and opioids in patients who do not have depression.[66] This  particular study did not differentiate between classes of antidepressants, limiting the ability of the Work  Group to recommend for or against prescribing opioids and a specific class of antidepressants. As such,  there is no recommendation in this guideline with respect to using specific classes of antidepressants and  LOT.  

Question: What does increase the AOR of  overdose?
Answer: the combination of zolpidem and opioids