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Are doctors replacing opioids with dangerous benzodiazepines?

Most of the country knows about the opioid epidemic and its tragic costs. Unfortunately, there appears to be another prescription drug crisis involving a class of drugs called benzodiazepines.

These drugs, traditionally prescribed for anxiety, insomnia or seizures, include brands such as:

  • Ativan
  • Halcion
  • Klonopin
  • Librium
  • Valium
  • Xanax

Benzodiazepines slow your breathing, depress the central nervous system and typically result in a marked difference in mental state. They are best for short-term use, as they can cause physical dependence and overdoses can be fatal.

Yet despite the known dangers of these powerful drugs, a recent study in JAMA Network Open found that the prescribing rate has skyrocketed since the opioid crisis. Between 2003 and 2015, the study says, outpatient treatment visits leading to a benzodiazepine prescription doubled. Furthermore, between 2005 and 2015, longer-term prescriptions jumped by 50 percent.

The study also found a four-fold increase in co-prescriptions of benzodiazepines with opioids since 2003. Sometimes, doctors may have been attempting to wean patients addicted to opioids, which would be better than simply cutting them off. However, the drugs can interact to further depress the central nervous system, increasing the risk of accidental death.

The overdose death rate from benzodiazepines has also risen. Previous research found that deaths from benzodiazepine overdoses grew by nearly 800 percent between 1999 and 2016. That translates to approximately 10,000 and 12,000 fatalities.

Largest increase in prescriptions comes from primary care doctors treating chronic pain

According to the JAMA Network Open study, about half of benzodiazepine prescriptions come from primary care physicians, not psychiatrists. And, the largest increase in the prescriptions appeared to be for the treatment of back pain and other chronic pain -- perhaps to avoid opioids.

Primary care physicians in the U.S. have relatively little time and resources to deal with a large volume of patients exhibiting complex symptoms. Usually they do not receive the extra training necessary to properly prescribe medications with a high risk for addiction and overdose. Yet, especially in rural areas, they may be the only providers.

"That's partly what got us into the opioid epidemic in the first place," commented a Stanford University School of Medicine professor focusing on addiction medication who was not involved in the new study.

Benzodiazepines have not been proven effective at treating chronic pain, and there are other, safer methods of treating anxiety and insomnia, doctors say. Primary care physicians would benefit from CDC prescription guidelines like those for opioids.

If benzodiazepine addiction and overdose isn't already an epidemic, it soon might be unless steps are taken (including increasing awareness) to stop and reverse the trend.

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