Drugs come in and out of fashion as easily as the clothes on our backs, a depressing, but true notion. Unfortunately, effectiveness measured against addiction risk isn’t the key determinant for whether someone is prescribed a powerful opiate for pain or a benzodiazepine medication for anxiety or insomnia. Instead, outdated and often misinformed literature, powerful ad campaigns by pharmaceutical companies, and drug representatives pushing for use of their company’s product, guide both the public’s perception of the effectiveness and uses of these drugs, as well as the physicians prescribing medications to their patients.
Benzodiazepines are effective sedative hypnotic and anticonvulsant drugs used to treat anxiety and insomnia. Coinciding use of both benzodiazepines and opiates has increased approximately 12 percent annually since 2002. Despite the known risk of combining two central nervous system depressants, rates of prescriptions written for both drug types per one patient is increasing more than 6 percent each year. Today, some combination of opiates and benzodiazepines accounts for more than 30 percent of overdose deaths in emergency rooms across the country annually.
Insurance coverage is one likely reason for the dual prescriptions. Patients who lack coverage for non-pharmaceutical care, like physical therapy or those with poor prescription coverage may end up on the combination to relieve pain and subsequent anxiety. Unfortunately, it is a powerful combination that is not only difficult to quit, but extremely dangerous.
Overdose Deaths And Central Nervous System Depressants
Opiates and benzodiazepines function differently, but have similar effects in depressing the central nervous system. Taken together, these drugs enhance their individual effects, leading to a potential for loss of consciousness and lethal respiratory depression. In fact, states have turned to using the combination of opiates and benzodiazepines during executions, in place of more expensive alternatives.
Opiates are narcotic analgesics, and work by binding with opioid receptors to alter our threshold for pain. A side effect is the relaxation of smooth muscle tissue and drowsiness. Similarly, benzodiazepines increase gamma aminobutyric acid (GABA), a nerve-calming neurotransmitter, which controls muscle tension and can induce a sleep-like state. Both drugs can depress breathing, but combined, the effect is potent and often lethal.
One recent study examined the impacts of benzodiazepine prescriptions for methadone-maintenance patients and noted that of the people prescribed both medications during their treatment, about half become physically dependent on the benzodiazepine and continue to take the drug, while also increasing their dose beyond levels prescribed. This is particularly troubling as the drug was never intended to be used for longer durations or at higher levels than prescribed. A higher dose can quickly enhance the effects of the opiates and depress vital functions like breathing.
Complications Of Using Benzodiazepines For Methadone Maintenance
Benzodiazepines like Xanax and Ativan are sometimes prescribed to patients undergoing methadone maintenance to help with insomnia or anxiety associated with withdrawal from heroin. While it is intended to be used in the short term as a preventative measure against relapse, the drug, much like methadone and heroin, has the potential for addiction. And like heroin, street availability of “benzos” is increasing.
Complicating matters is that withdrawals for both opiate drugs like methadone and heroin, as well as benzodiazepines, are similar. Patients may increase their dosage of either drug to keep perceived withdrawal symptoms at bay. Withdrawals for both drug types can be severe and cause significant distress.
Someone with a history of mental illness or addiction is more at risk of developing a physical dependence on benzodiazepine medications while undergoing treatment for opiate addiction. As mentioned earlier, one study indicated that of those who began using benzodiazepines therapeutically while undergoing methadone maintenance, half became physically dependent on the drug. While used initially to stave off relapse, co-prescribing these drugs, if not monitored properly can result in polysubstance abuse.
Risk Factors for Co-occurring Opiate and Benzodiazepine Abuse
- Co morbid Opiate Addiction and Mental Disorder
- Methadone Maintenance
- Therapeutic Prescription of Benzodiazepines
- History of Polysubstance Abuse
- History Chronic Pain
- Poor Insurance Coverage
- No Routine Monitoring
Opiate and benzodiazepine co-occurring abuse is one of the most common causes of overdose deaths in emergency rooms across the country. The rate of overdose deaths involving opiates and benzodiazepines has increased more than 14 percent annually. White, middle-aged men were more likely to overdose than any other demographic.
What Makes Overdose More Likely With Opiates And Benzodiazepines?
Due to the nature of the drugs, especially a benzodiazepine medication, which can cause short-term memory loss, people taking the drug may inadvertently take more. The drug also functions a bit like alcohol in that someone using a benzodiazepine medication may not be aware they are already feeling the intoxicating effects, and increase the dose to achieve a desired result.
For those undergoing methadone maintenance therapy, benzodiazepine medications, unlike other opiates, can induce a euphoric rush. Someone attempting to overcome an addiction to heroin is at greater risk of becoming addicted to the intoxicating effects of the drug.
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