The dose makes the poison – Paracelsus

The MMWR recently reported that in the current problem with the abuse of prescription drugs, alcohol plays a significant role in ED department visits, including opioid pain reliever (OPR) and benzodiazepine (BZP) drug-related deaths. Using the SAMHSA Drug Abuse Warning Network, data was analyzed from 237 hospitals on ED visits as well as other data on drug-related deaths in 13 states.

It was estimated that in the U.S. in 2010 there were 438,718 ED visits related to OPRs and 408,021 related to BZP use. Among those visits, an estimated 18.5% and 27.2% also involved alcohol, respectively. Of the total ED visits, concomitant alcohol-OPR use was highest in the 30-54 year-old age group. Concomitant alcohol-BZP use was highest among the 45-54 year-old age group and was more common among men than among women.

Of the 3,883 OPR deaths in the 13-state survey in 2010, 22.1% involved alcohol and for BZP related deaths 21.4% involved alcohol. Among the OPR deaths, persons aged 40-59 had the highest percentage and for BZP deaths the highest percentage was among persons > 60 years of age.

Alcohol use and risk for abuse should be a part of the screening process when considering prescribing opioids or benzodiazepines to patients.

The use of SBIRT, Screening, Brief Intervention and Referral for Treatment, provides a tool for alcohol risk screening and is a benefit of Medi-Cal and PHC that is reimbursed outside of capitation.

Marshall Kubota, MD

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