Description
Background Anxiety and opioid use disorder (OUD) are frequently comorbid. Individuals initiating treatment for OUD often use prescribed or non-prescribed benzodiazepines to manage anxiety symptoms, yet their use alongside opioid agonist therapy remains poorly understood. This study characterizes benzodiazepine use before and after buprenorphine treatment for OUD and identifies covariates associated with new benzodiazepine initiation after treatment start. Objective: To describe patterns of anxiety diagnosis and benzodiazepine use surrounding buprenorphine initiation and identify predictors of incident benzodiazepine use among anxiety- and benzodiazepine-naive patients. Methods We conducted a retrospective cohort study using IBM MarketScan Commercial Claims data. Adults initiating buprenorphine for OUD were followed for 180 days before and after treatment start (N=4,653). The incident-use analytic cohort excluded patients with any pre-index benzodiazepine use or anxiety diagnosis (N=1,703). The primary outcome was any benzodiazepine fill in the 180-day post-index period. Multivariable logistic regression estimated adjusted odds ratios (aOR) for incident benzodiazepine initiation, adjusting for age, sex, mood disorders, sedative abuse history, pain conditions, and pre-index opioid use. Results: In the full cohort, 42.6% had a pre-index anxiety diagnosis and 57.8% were diagnosed with anxiety at any point in follow up. Prescribed, pre-index benzodiazepine use was documented in 25.7% of patients, and 24.5% filled a benzodiazepine post-index. Among the 1,703 anxiety- and benzodiazepine-naive patients, 276 (16.2%) initiated a benzodiazepine within 180 days of buprenorphine start. Pre-index sedative use disorder (aOR 2.80; 95% CI 1.88, 4.17), chronic, pre-index prescribed opioid use (aOR 1.99; 95% CI 1.44, 2.75), acute pre-index prescribed opioid use (aOR 1.86; 95% CI 1.33, 2.59), and bipolar disorder (aOR 1.71; 95% CI 1.08, 2.71) were independently associated with incident benzodiazepine initiation. Patients aged 40-49 had lower odds than those aged 18-29 (aOR 0.64; 95% CI 0.43, 0.95). Conclusions: Anxiety diagnoses increase markedly following buprenorphine initiation, and more than one in six anxiety- and benzodiazepine-naive patients subsequently fill a benzodiazepine. History of sedative use disorder, pre-index prescription opioid use, and bipolar disorder identify patients at elevated risk. Findings support routine anxiety screening and monitoring for concurrent benzodiazepine prescribing at buprenorphine initiation.
Publication Info
2026.