Prescriptions for benzodiazepines have soared in the past decade, causing an alarming rise in overdose deaths when the tranquilizers are taken with opioid painkillers, according to a new study by Stanford researchers.
Benzodiazepine medication such as Xanax, Klonopin and Ativan — also known as “benzos” – are used primarily to treat anxiety, mood disorders and insomnia. But they are being prescribed at greater rates than ever before and addicts are using them to enhance their highs.
Actor Philip Seymour Hoffman, who died last month from a drug overdose, had heroin, cocaine, benzodiazepines and amphetamines in his system, according to the New York medical examiner.
Researchers say the prescribing of benzodiazepines grew by 12.5% a year between 2002 and 2009. Patients being prescribed opioids were 4.2 more likely to also have simultaneous prescriptions of benzodiazepine. In fact, joint prescriptions of benzodiazepines and opioids increased by 12% a year.
The combination turned up in nearly a third of the 16,651 overdose deaths in 2010 involving opioid painkillers, according to data from the U.S. Centers for Disease Control and Prevention.
“More research is needed to elucidate the reason behind the increase in benzodiazepine prescription, and a national effort is needed to highlight the danger of co-prescription of benzodiazepines and opioids,” said principal investigator Sean Mackey, MD, director of the Stanford Systems Neuroscience and Pain Lab.
Many pain patients are on an opioid/benzodiazepine regimen that can last for years.
“They are prominent fellow travelers with opioids,” Len Paulozzi, MD, a medical epidemiologist with the CDC told MedPage Today. “The problem is, people get on them and they stay on them forever.”
“As a complex, emotional experience, pain often is accompanied by significant alterations of mood, in particular anxiety,” said study co-author Ming-Chih Kao, MD, a clinical assistant professor at Stanford University Medical Center.
Kao says benzodiazepines are good medications to treat anxiety, but when taken with opioids there is a greater risk of depressing the central nervous system, which can lead to respiratory failure and death.
He called for better coordination between prescribers of opioids, who are often primary care physicians or pain specialists, with prescribers of benzodiazepines, who are often psychiatrists.
“The increased prescribing of benzos is directly related to the increased prescribing of opioids,” said Percy Menzies, president of Assisted Recovery Centers of America, in an email to National Pain Report.
“Opioid addicts will often compartmentalize their symptoms, obtaining prescriptions for opioids from one doctor and prescriptions for benzos from other doctors. When patients test positive for benzos, they will admit that they need to benzos for their ‘panic’ attacks.”
Menzies says short-acting benzodiazepines, such as Xanax, Klonopin, and Ativan, have an abuse potential of their own.
“The relatively short ‘high’ is often used to mitigate the anxiety of withdrawal from opioids. Opioid addicts have attempted to combine the high from the opioids and the benzodiazepines, especially through IV use.”
The Stanford study was presented this week at the annual meeting of the American Academy of Pain Medicine.