PUBLIC HEALTH
March 8, 2016

The Next Wave of Overdoses

Overdoses and deaths from anti-anxiety drugs like Xanax and Valium are way up. Here's why.

Painkillers like OxyContin have been correctly identified as gateway drugs for opiate addiction. But doctors and the people who use them should not overlook the dangers of benzodiazepines. Overdoses due to these drugs have been on the rise, according to a recent study.

Benzodiazepines act on the central nervous system. This class of drugs has sedating effects and is typically used to treat anxiety, panic disorders, muscle spasms, seizures, sleeplessness and alcohol withdrawal.

Uses and Side Effects

The most commonly prescribed medications in this class are alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan), temazepam (Restoril) and triazolam (Halcion). These drugs are also used to provide conscious sedation during medical and dental procedures.

When benzodiazepines are used in combination with narcotics, painkillers, barbiturates, alcohol and sleep medications, they can bring on respiratory depression, excessive drowsiness, sedation, lethargy and, in severe cases, coma and death.

When used appropriately and as directed, benzodiazepines can be safe and effective. They require a prescription and are classified as controlled substances because of their high potential for abuse, addiction and diversion (selling illegally on the street.) In 2008, about 5% of American adults filled one or more benzodiazepine prescriptions.

Lightheadedness, drowsiness, confusion, sedation and memory impairment are common side effects, but benzodiazepines can also interact with other medications and cause more serious side effects.

Since they are designed to depress the nervous system, when benzodiazepines are used in combination with narcotics, painkillers, barbiturates, alcohol and sleep medications, they can bring on respiratory depression, excessive drowsiness, sedation, lethargy and, in severe cases, coma and death.

In 2013, almost 23,000 Americans died of an overdose involving prescription drugs and one-third of these deaths are estimated to be from fatal overdoses of benzodiazepines, according to the study just published in the American Journal of Public Health.

Using health records between 1996 and 2013, researchers determined how many adults were filling prescriptions for benzodiazepines and how many adults had fatal overdoses during the same time period. They found the number of adults buying benzodiazepines increased by 67%, from 8.1 million to 13.5 million during the 17 years covered by the study. The quantity of benzodiazepines being prescribed to patients also increased.

The most common reasons for prescribing the drugs were anxiety, mood disorders and insomnia.

Several Deadly Trends

The overdose death rate increased four-fold during the study period. And though the overall death rate leveled off after 2010, it continued to increase for people over 65 and among African Americans and Hispanics throughout the study period.

Always consult your doctor when adding benzodiazepines to other prescription or over-the-counter medications.

The number of deaths from benzodiazepines has risen even faster than the increase in prescriptions filled. This seems to be the result of substantial increases in the doses people take. Whether they are taking a higher daily dose, or taking the medication for longer periods of time, both raise the risk of fatal overdose.

Among those people who obtain the drugs illegally, the risk of overdose is much higher. Without medical supervision, illegal users may take benzodiazepines while drinking alcohol or with other medications, including opioid painkillers, a particularly dangerous combination, which greatly increase their risk of overdose.

This study makes clear that opioids are not the only prescription medications consumers need to be careful about. Anti-anxiety and sleep medications are potentially just as dangerous. The findings highlight the growing risk of overdose mortality and focuses attention on the need for interventions to improve the safe use of benzodiazepines.

Always consult your doctor when adding benzodiazepines to other prescription or OTC medications. Patients should not take medications prescribed to others and should avoid mixing alcohol and recreational drugs with prescription medications. And, of course, parents should keep their medications out of sight and reach of their children and teens.

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