Title: Recommendations

Context:
Subgroups at higher risk: Risk of prescription opioid overdose is elevated across MEDD dosage levels in patients with co-occurring depression (moderate quality evidence).[66,133] Following an elevated baseline adjusted risk ratio (ARR) of 3.96, depressed patients taking 1-19 mg, 20 to <50 mg, 50 to <100 mg, and ≥100 mg MEDD had respective odds of overdose of 4.75, 5.47, 6.44, and 7.06, compared to those taking an opioid at the same dosage level without a diagnosis of depression.[66] Similarly, a history of or active SUD increases risk for serious prescription opioid-related toxicity or  overdose across opioid dosages (moderate quality evidence).[58,87,133] A retrospective cohort review of  patients with CNCP receiving LOT at least five days per week for 90 days determined that those with a  history of non-opioid SUD had 28 times the odds of developing OUD.[87] Each 50 mg increase in MEDD  nearly doubled the odds while each 100 mg MEDD increase tripled the risk for OUD. Concurrent  prescribing of sedative-hypnotics and benzodiazepines increases risk of fatal or non-fatal opioid overdose  2-10 fold across opioid dose ranges.[66,133,135]

Question: What does increase the risk of fatal or non-fatal opioid overdose 2-10 fold across opioid dose ranges?

Answer: Concurrent  prescribing of sedative-hypnotics and benzodiazepines