The deadly correlation between two common drugs
The US National Institute on Drug Abuse explains us about the dangerous correlation between two commonly prescripted drugs: benzodiazepines and painkillers. First one are generally prescribed for anxiety and insomnia while the second to stop physical pain.
In a study conducted over 300.000 deaths connected with the use of opioids 17% out of them where found positive to benzodiazepines.
Opioids are responsible for the death of 115 american each and every day. But this doesn't seem to lead to a more strict control over their prescription.The same is for benzodiazepine.
From 1996 to 2013 the number of users of Xanax, Valium, Klonopin and Ativan, the most used among benzodiazepines, rise in the US from 8,1 million to 13,5 million. Also the quantity obtained rise from 1,1 kg to 3,6 kg per 100.000 adults.
Much of benzodiazepines prescriptions to high risk drug users are done with legitimate therapeutic aim. But their abuse is common, especially when they are used for longer than two or three weeks, forming part of polydrug use patterns normally together with alcohol or illicit drugs.
The study mentioned showed that combined use of benzodiazepines and opioids could easily lead to a drug related emergency. But in spite of the danger people prescribed of both drugs are constantly rising. A 2015 study from European Monitoring Centre for Drugs and Drug Addiction reveals that misuse of benzodiazepines "contributes to increased morbidity and mortality among high-risk opioid users. It increase the risk of opioid overdose and is associated with a higher risk of acquiring HIV infection, experiencing anxiety and depression, and having poorer treatment outcomes and poorer social functioning".
A deadly mix
As their correlated misuse shows benzodiazepines are usually connected with self-medicate or increasing the opioids effects. In fact opioid addict use of banzodiazepines is related with psychiatric disorders treat, or in alternative to fix opioids withdrawal symptoms, and the side effects of alcohol and cocaine use. In fact benzodiazepines especially when injected can prolong the intensity and duration of opioid effects.
In this case banzodiazepines most related with opioid epidemic deaths are diazepam, clonazepam, alprazolam, axazepam and flunitrazepam. What do they all have in common is a more rapid onset of action. Sometimes the choice between them is simply prompted by their availability and price. In France restrictions on flunitrazepam leads to a wider misuse of clonazepam.
In the UK the withdrawal of temazepam leads to an increasing use of diazepam, phenazepam and etizolam. Phenazepam, which is under control now, is linked with a number of deaths and hospitalizations, as it can cause psychomotor impairment, respiratory arrest, psychosis and delirium.
It is sold on the internet and the illicit market as powder, tablets or blotters.
As a 2016 study on the Impact of High-Dose opioid Analgesisc on Overdose Mortality shows in North Caroline found that the overdose death rate among patients using both type of medications was 10 times higher than among those using opioids only. In another canadian study among patients using non cancer painkiller 60% were found positive to benzodoiazepines.
Even a study conducted over US veterans found that among those of them with an opioid prescription who were receiving also benzodiazepines the risk of drug overdose was sensibly increased. In 2016 the Center for Disease Control and Prevention (CDC) recommend to avoid prescribing at the same time opioid and benzodiazepine whenever possible. As a consequence of that both drugs families must show on their boxes an FDA label warning the danger of assuming together the two of them. Patients using one of them must also informs their doctors in order to avoid the risk of overdose. (cm)
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