Research Spotlight: Reported Risky Alcohol Use Among US Adults Prescribed Three Classes of Chronic Alcohol–Interactive Medications

Eden Bernstein, MD, a physician scientist in the Department of Medicine at Massachusetts General Hospital is the author of a recently published Research Letter in JAMA, Reported Risky Alcohol Use Among US Adults Prescribed 3 Classes of Chronic Alcohol–Interactive Medications

What was the question you set out to answer with this study?

How many U.S. adults taking chronic high-risk alcohol-interactive medications (benzodiazepines, opioids, and antiepileptics) reported risky alcohol use during the time they were prescribed these drugs?

Alcohol-interactive medications pose increased risk of adverse events and death when used with alcohol. Mortality rates from alcohol and such medications have since increased.

What Methods or Approach Did You Use?

We used the National Health and Nutrition Examination Survey, a national survey that uses a complex sampling design that can be used to describe nationally representative estimates.

We used the 2013–March 2020 National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of noninstitutionalized US civilians conducted through home interviews and mobile examination centers.

We included adults 20 years or older who were taking one of three classes of alcohol-interactive medications (72 drugs total); benzodiazepine receptor agonists (BZRAs), opioids, and antiepileptics. These were chosen due to their potential for severe adverse events including sedation, delirium and overdose

Only medications taken for at least 365 days were included in order to temporally align medications with alcohol use.

What Did You Find?

We identified 2,141 adults taking chronic BZRAs, opioids, or antiepileptics (weighted mean age, 56.1 years [SD, 15.6]; 59.4% female), representing 11.4% (95% CI, 10.6%-12.2%) of US adults 20 years or older. Of those taking these medications, 23.9% reported risky alcohol use in the past year.

What are the Implications?

In this nationally representative sample, risky alcohol use was reported by more than one in five adults taking chronic BZRAs, opioids, or antiepileptics. Findings suggest a need to prioritize screening and interventions to reduce risky alcohol use among patients taking these medications who are at high risk for adverse events.

Study limitations include examination of only three classes of alcohol-interactive medications and the inability to determine whether drinking coincided with medication use. However, self-reported data may underestimate alcohol use. Given the number of respondents taking these medications, precision was limited when extrapolating to the U.S. population.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.