Long-Term Benzodiazepine Use in COPD, PTSD May Increase Suicide Risk, Study Says

Benzodiazepines are typically prescribed to treat chronic obstructive pulmonary disease (COPD) symptoms and are also typically prescribed for those with posttraumatic stress disorder (PTSD). However, a recent study found that long-term use of benzodiazepine medications in patients with both COPD and PTSD may be associated with a greater suicide risk.

The researchers aimed to evaluate the mortality risks of long-term benzodiazepine exposure among those with COPD and PTSD. The study used data from the Veteran’s Health Administration to identify patients with COPD and PTSD between 2010 to 2012. The propensity scores for benzodiazepine use were calculated and compared the cause of mortality among those with long-tern benzodiazepine use, according to the researchers.

"The use of benzodiazepines among patients with high-risk comorbidities is a frequent dilemma for patients and clinicians," Lucas M. Donovan, MD, a pulmonary, critical care and sleep physician and health services researcher at the VA Puget Sound Healthcare System and study author, said in a statement. "Understanding the risks of benzodiazepines is difficult because the symptoms that prompt their use, including anxiety and shortness of breath, are themselves linked with poor outcomes."

The study matched patients by considering over 44 patient characteristics, including medical and psychiatric history, medication use, and healthcare utilization. Of the 44,555 eligible patients with COPD and PTSD, 23.6% of them received benzodiazepines long-term.

Furthermore, no mortality difference was observed in the long term in the matched sample of 19,552; however, a greater risk of death by suicide was observed for those with long-term use. Also, of the matched and unmatched patients, short-term benzodiazepine use was associated with increased mortality, according to the results.

"Although long-term benzodiazepine use among patients with COPD and PTSD is not linked with overall mortality, the association with suicide is concerning," Dr. Donovan concluded. "More research will be needed to better understand this link with suicide, but in the meantime we would advise that clinicians reconsider prescribing benzodiazepines to patients who already are at high risk for self-harm."

The authors noted that the results do not suggest discontinuing long-term benzodiazepines would reduce overall mortality or death, rather providers should consider the discontinuation of the medication among patients who are at a high risk of suicide, while also avoiding concomitant opioid use. Specifically, according to the study, providers should be aware of the risks of new benzodiazepine prescriptions for COPD and PTSD patients without prior exposure.

Reference

Donovan LM, Malte CA, Spece LJ. Risks of benzodiazepines in chronic obstructive pulmonary disease with comorbid posttraumatic stress disorder. [published online Octtober 12, 2018]. Ann Am Thorac Soc. doi: 10.1513/AnnalsATS.201802-145OC.