Benzodiazepine Abuse: Beyond The Opioid Crisis
Awareness surrounding the use of opioids has been increasing steadily over the past few months, but many say oft-overlooked factors are contributing to the epidemic – namely, benzodiazepine abuse.
Benzodiazepines (or benzos for short) are anti-anxiety drugs which include such name brands as Xanax and Valium. While it’s relatively difficult to overdose on these drugs on their own, when they are mixed with other substances such as opioids or alcohol, they can combine to form a toxic cocktail far more potent than any one drug alone.
Indeed, according to a 2016 study by the American Journal of Public Health, benzos were involved in 30% of all overdoses between 1966-2013 nationally. Not coincidentally, prescriptions for these drugs rose 30% over that period, as well.
Another fact: the report also found that the prescribed dose of benzos per patient doubled between 1996-2013, which means that not only were more people prescribed the drugs, higher amounts were prescribed for each individual:
“Benzodiazepine prescriptions and overdose mortality have increased considerably. Interventions to reduce the use of benzodiazepines or improve their safety are needed.”
A Massachusetts Department of Public Health evaluation of overdoses related to opioids from 2011-2015 found that regardless of the opioid that was responsible for the overdose, benzos were also present in more than half the cases.
From the report:
“What is especially notable is the epidemic’s rapid and insidious geographic spread throughout the Commonwealth. Almost every community is affected.”
Nationwide, the Food and Drug Administration (FDA) reports that the number of prescriptions for opioids increased by just 8% from 2002-2014, but prescriptions for benzos rose by 31% by comparison. Furthermore, the FDA says that 2.5 million more patients in 2014 were prescribed both a benzo and an opioid than in 2002.
During that time, the number of opioid overdose deaths that also included a benzo increased from 18% to 31% nationally.
The Toxic Cocktail
Last year, a study from the Stanford School of Medicine revealed that despite being overlooked in the opioid epidemic, the combination of benzos and opioid is particularly dangerous.
Because both drugs are central nervous system depressants, combining the two can slow or stop heart and lung function
In 2016, the FDA began requiring boxed warnings on close to 400 different drugs containing benzos to inform consumers about the dangers of mixing benzos and opioids. Combining the two medications can also reduce the effectiveness of naloxone, the drug used to bring opioid overdoses back from the brink of death.
And some benzos can remain active in a user’s system for up to a full day. According to the FDA for example, Xanax can remain in an adult’s system between 6-26 hours.
And there are even more dangers: heroin being cut with benzos as an inexpensive way to induce a high. And in these cases, the person would be unaware that the drug they were taking contained substances that increase the risk of overdose and death.
Flying Under The Radar
For people battling the opioid crisis every day, the potentially deadly consequences of mixing opioids and benzos have been tragically well-known. The uptick in prescriptions can be traced back to near the turn of the century when the Joint Commission that accredits health organizations issued its pain standards report.
This report discussed the dynamics of pain measurement, and as a vital sign, that pain cannot be evaluated objectively. Moreover, pain is measured by asking the patient to rate their pain level on a scale that shows a series of faces ranging in emotions from smiles to frowns.
The 2001 report contends that “patients have the right to assessment and management of pain.” And while the Joint Commission states that this message was misinterpreted, it appeared to set the balling rolling, because what followed was an increase in opioid prescriptions and pain clinics or “pill mills” that dispensed drugs like benzos and opioid indiscriminately.
And many experts and health officials believe that it this trend of the over-prescribing of medication that has led to the drug epidemic in the U.S. – a crisis that is now killing more people than HIV/AIDS at its peak in 1996.
Recent statistics from the CDC reveal that 4 out of 5 new heroin users report first beginning their habit after becoming addicted to prescription drugs. As a result, overdose deaths are now being led by heroin and fentanyl, while deaths due to painkillers seem to be leveling off slowly.
But the fact is, the drug epidemic is not just about opioid or benzodiazepine abuse – substance abuse, in general, has increased in the last few years for all types of drugs and alcohol, among most age groups, races, and both genders. In 2016, the CDC estimates that more than 64,000 people in the U.S. died from an overdose related to drugs or alcohol.
~ G. Nathalee Serrels, M.A., Psychology, Author of Benzodiazepine Abuse: Beyond The Opioid Crisis