Dangerous Drug Combinations: 6,149 Opioid+Benzo Co-Prescribers

Why This Matters

Opioids and benzodiazepines are each central nervous system depressants. When taken together, they compound respiratory depression — the mechanism behind most overdose deaths. According to the CDC, roughly 16% of opioid overdose deaths also involve benzodiazepines. The FDA's 2016 Black Box Warning was an unprecedented step, requiring updated labels on nearly 400 products.

Despite the warning, our analysis of the 2023 Medicare Part D dataset identified 6,149 providers who prescribe both opioids and benzodiazepines at rates that significantly exceed their specialty peers. These are not occasional prescribers — they are statistical outliers whose concurrent prescribing patterns warrant scrutiny.

Top 50 by Anomaly Score

We rank co-prescribers by an anomaly score that accounts for the volume and rate of concurrent prescribing relative to specialty norms. A higher score indicates greater deviation from expected patterns.

Breakdown by Specialty

Co-prescribing patterns vary significantly by specialty. The most common specialties among flagged co-prescribers:

Breakdown by State

Geographic patterns in co-prescribing often mirror broader opioid crisis hotspots:

Methodology

Our co-prescribing analysis identifies providers who prescribe both opioid and benzodiazepine drug classes at rates exceeding their specialty-adjusted peer group mean by more than 2 standard deviations. The anomaly score combines the z-scores for opioid rate, benzodiazepine rate, and concurrent prescribing volume into a single composite metric. We use CMS Medicare Part D data which includes all claims for providers with 11+ claims per drug.

It is important to note that some concurrent prescribing may be clinically appropriate — for example, in palliative care or carefully managed chronic pain. A high anomaly score does not necessarily indicate malpractice, but it does indicate a prescribing pattern that deviates significantly from peers and warrants review. Patients should discuss any concerns with their healthcare provider.