Drug-related deaths tend to make the headlines when someone famous dies from an overdose, but such high-profile cases are only a small fraction of the deaths that occur annually. In fact, the National Institute on Drug Abuse attributes more than one hundred and fifteen deaths per day to opioids. The opioid epidemic claims thousands of lives every year, but many people don’t know that these deaths are often the result of a lethal combination of opioids and benzodiazepines.
Benzos, as they are commonly called, are a class of drugs that are widely prescribed for their sedative properties. They include well-known medications like Klonopin, Librium, Xanax and Valium. They interact with the GABA receptor (the most common neurotransmitter in the nervous system) by binding to the GABA chloride channel on the cell’s surface. This causes an inhibitory action that reduces neurons’ excitability and produces a calming effect on the brain. Benzos should be used for short periods because they are highly addictive. Long-term use can result in tolerance and dependence, but it can also render them ineffective and make symptoms worse.
People who are dependent on opioids tend to experience chronic withdrawal symptoms, which manifest as sleep disturbances and anxiety disorders. Doctors who are not trained as addiction specialists often misinterpret the reason for these manifestations and prescribe benzos to treat them. This combination works until the benzos begin to cause their own withdrawal symptoms, in which case doctors often escalate the dosages of both medications. Research supports this treatment because it does modulate pain and the insular cortex firing that is associated with it, but not for the long-term.
Despite the fact that using opioids and benzos concurrently can have disastrous results, they are often prescribed together. Used sparingly (and with careful medical supervision) the duo can be very effective, for treatment of pain and anxiety, but unfortunately, this regimen often leads to abuse. When benzos (which are used to treat anxiety and insomnia) are added to opioids, they tend to increase and extend the euphoric state that is achieved by the painkillers. The combination can be deadly because it depresses the central nervous system’s medullary controls for respiration and heart rate. Also, use of the two drugs together is not equal to two doses of medication – the combination creates a synergistic effect that has exponentially higher potential on the brain to suppress respiration. Unchecked, this can lead to coma and death – and when alcohol is added into the mix, things can spiral downward very quickly. Once basic bodily functions are compromised, the brain is deprived of oxygen, the cardiovascular system is slowed, and vital organ systems will start shutting down.
It should be noted that taking these drugs together can be extremely dangerous even when they are being taken as directed, which is why the medical community is now being encouraged to avoid the combination if at all possible. In 2016, the United States Food and Drug Administration issued black box warnings on nearly four hundred products to warn about the dangers of combining these medicines and that same year, the Centers for Disease Control and Prevention issued guidelines on opioid prescribing which urge physicians to avoid prescribing the potentially lethal combination.
Patients who enter addiction treatment report higher rates of concurrent opioid and benzo use. This population requires close medical supervision in order to have any chance at a successful recovery. As with opioids, the use of benzos can lead to a physical dependence that makes functioning without them very difficult. Withdrawal from these medications must be medically managed because stopping the drug abruptly is extremely dangerous and can cause seizures and psychosis. Post-acute withdrawal syndrome (which lasts for up to a year) is also common and occurs even under a doctor’s care, but is a condition that also needs to be medically managed.
Another growing concern focuses on what is called low-value care. This is care that is not evidence-based and is potentially harmful, unnecessary or redundant. The fee-for-service payment program is largely to blame for perpetuating low-value care because it rewards providers financially for delivering more care, but not necessarily the right care. It is a system that can inappropriately favor quantity over quality, which causes iatrogenic patient harm, raises costs, and interferes with the delivery of high-value care. Hazardous treatment choices (like prescribing combinations of opioids and benzos) represent an important and relatively common form of high risk/low-value care.
When opioids or benzodiazepines are abused separately, physical dependence and addiction are likely to occur, but concurrent abuse can be deadly. Before taking any of these medications, it is critical to understand the potential for misuse and abuse. Even short-term use can cause a physical dependence that may require many months to detox. If your physician is suggesting concomitant use of opioids and benzos, extreme care must be taken to avoid the pitfalls associated with this regimen. Every patient must actively participate in his/her own healthcare. Just because a “doctor prescribed it” doesn’t necessarily mean that it’s the most appropriate treatment or even safe. Educating oneself about the risks and benefits of the treatments being offered is vital when it comes to making the right decision about one’s healthcare.
If you or someone you know is abusing narcotics, please seek professional help.
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