Primary Care Alert: Risky alcohol use in the past year was found highest among persons taking benzodiazepines, followed by those taking opioids, and taking antiepileptics.
One in 5 US adults taking 1 of 3 classes of chronic alcohol-interactive medications reported risky alcohol use in the past year with some reporting binge drinking while on the medications in the past month. Individuals taking benzodiazepines had the highest prevalence of past-year risky alcohol use.
The study findings were published online in a Research Letter to JAMA on September 14, 2023.
Using 3 cycles of data from the National Health and Nutrition Examination Survey (NHANES) investigators from the Massachusetts General Hospital and Beth Israel Deaconess Medical Center in Boston examined the prevalence of risky alcohol use among adults in the United States who were prescribed medications from 3 classes of drugs known to have potential severe adverse effects when combined with alcohol: benzodiazepines, opioids, and antiepileptics.
According to the team, the most recent study of use of alcohol and alcohol-interactive medications includes data only through 2010. And while fatalities related to the toxic combinations have increased since then, they also cite data showing less than 3% of primary care visits between 2014 and 2016 included alcohol use screening with guideline-recommended tools.
To capture more current information on the dangerous behavior, the team identified 2141 adults in NHANES cycles 2013-2014, 2015-2016, and 2017–March 2020 taking 1 of the 3 classes of medications (72 drugs total), representing 11.4% of all US adults aged 20 years or older.
The primary outcome of interest was past-year risky alcohol use which investigators defined as presence of either any binge drinking (≥4 drinks on 1 occasion for women, ≥5 for men) or heavy weekly drinking (≥8 drinks per week for women, ≥15 for men). They also assessed subcategories of past-year use defined as any binge, heavy weekly drinking, and 12 binges or more. They characterized the prevalence of risky alcohol use across the overall NHANES population and among those taking alcohol-interactive medications.
The cohort had a weighted mean age of 56.1 years and 59.4% were women.
Risky alcohol use. Prevalence of past-year risky alcohol use among all US adults was 34.0% and past month binge drinking was 23.4%
Use among medication users. Prevalence of past-year risky alcohol use among adults taking the alcohol-interactive medications was 23.9%, and past-month binge drinking was reported by 13.8% of them.
Prevalence estimates varied by sociodemographic characteristics, including age and insurance status.
Variation by drug class. Prevalence of any past-year risky alcohol use was highest among those taking benzodiazepines (28.6%), followed by those taking antiepileptics (20.2%) and opioids (17.5%). Prevalence among those taking multiple classes of these medications was 15.3%.
The authors point to several study limitations including that only 3 classes of alcohol interactive medications were examined and that it was not determined whether alcohol use coincided with medication use. Additionally, self-reported data may underestimate alcohol use, and the precision of the finding when extrapolated to the entire US population was limited given the number of respondents taking these medications.
The finding that more than 20% of US adults who take these medications chronically also engage in risky use of alcohol should prompt health care providers to screen for the behavior and consider brief interventions, wrote the investigators. Clinicians also should consider harm reduction strategies, including exploring alternative lower-risk medications.