Benzos and the Opioid Crisis

Benzos and the Opioid Crisis
Posted on 04/04/2018
Tom Petty, Lil Peep, Philip Seymour Hoffman, DJ AM, Heath Ledger, and more, have died in the last decade. All from overdose involving opioid pain killers and benzodiazepines anxiety medications.

As the opioid crisis spreads across the country like wildfire, it is quietly being fueled by benzodiazepines. Nationally in 2016, 30% of fatal opioid-associated overdoses involved benzodiazepines, and 75% of fatal benzodiazepine-associated overdoses involved opioids.1,2

This deadly combination is responsible for an even greater percentage of deaths right here in Harris County. Countywide in 2016, 53% of fatal opioid-associated overdoses involved benzodiazepines, and 83% of fatal benzodiazepine-associated overdoses involved opioids.3

“There is a ten times higher risk of opioid overdose when taken with a benzodiazepine,” said Dr. Joy Alonzo, Clinical Assistant Professor of Pharmacy Practice at Texas A&M.

Benzos and opioids both act on receptors in the central nervous system (CNS). The CNS controls the set point for basic body functions like heart rate, breathing rate, and temperature. Although they act on different receptors, their effects overlap. When taken together the effects are intensified, like pouring gasoline on a fire.

To put it simply, “[This combination] causes people to stop breathing,” Alonzo said.

In 2016, the CDC issued new guidelines for prescribing opioids and the FDA issued black box warnings for all opioid or benzodiazepine containing medications.4,5 The CDC recommended that physicians avoid prescribing opioids and benzodiazepines at the same time whenever possible and the FDA warned about the serious dangers of taking them together.

Part of those guidelines include having providers use a Prescription Drug Monitoring Program (PDMP). PDMPs are electronic databases that track controlled substance prescriptions, like opioids or benzos, within a given state. They are intended to help ensure that medications are being prescribed appropriately and for legitimate medical use. A PDMP already exists in the state of Texas, but there is currently no law requiring physicians to use it before prescribing controlled substances.6

“In 2019, all physicians [in Texas] will be required to log into the PMP to make sure [patients] aren’t on both drugs,” Alonzo stated. “Since [a similar policy] went into effect in the state of New York, it has cut down the number of dual prescriptions by 75%, resulting in fewer deaths.”

What can YOU do? Protect yourself by writing out a list of all medications and dosages that you are taking and keep it with you. Whenever you go to your primary care doctor, see a specialist, visit the ED, or go to the dentist let them make a copy so they know for sure what you’re taking. Protect your family by safely storing your medications in a locked container and appropriately disposing of unused medications.

Together we can put out this fire, stop its destruction, and save lives.

References:

1 National Institute on Drug Abuse. 2017. Trends & Statistics Series: Overdose Death Rates. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.

2 Jones, C. M., and J. K. McAninch. 2015. Emergency department visits and overdose deaths from combined use of opioids and benzodiazepines. American Journal of Preventive Medicine 49 (4):493–501. doi:10.1016/j.amepre.2015.03.040. https://www.ncbi.nlm.nih.gov/pubmed/26143953.

Data obtained from Harris County Institute of Forensic Sciences. Analysis performed by Rhett Lacey

4 Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1.

5 U.S. Food and Drug Administration. (2016). FDA requires strong warnings for opioid analgesics, prescription opioid cough products, and benzodiazepine labeling related to serious risks and death from combined use. FDA News Release, August 31. www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm518697.htm.

6 http://www.pharmacy.texas.gov/PMP/

About the author:

Rhett Lacey served as Coalition Intern from February – March 2018 in the Nutrition and Chronic Disease Prevention Division at Harris County Public Health. He will receive a Master of Science in Physician Assistant Studies, and a Master of Public Health from Touro University California in May 2018. He holds a Bachelor of Science in Human Physiology and a Bachelor of Arts in Biology from The University of Iowa, as well as an Associate of Science in Paramedicine from Kirkwood Community College. Throughout his career, Rhett has focused on researching the topics of treatment and prevention in medicine. To learn more about the North Harris County Substance Abuse Prevention Coalition, please visit our About page.

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