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Thousands of Americans are dying each year from mixing opioids and benzodiazepines. In 2010, there were about 16,650 overdose deaths tied to prescription opioids. That is more than a four-fold increase from the 4,030 deaths in 1999, according to the CDC. (Medpage Today)   Actor Phillip Seymour Hoffman’s autopsy results showed a mixture of opioids, benzodiazepines and other drugs in the drug concoction responsible for his death.

“Prescription records show that as use of opioids like OxyContin and Vicodin soared in the 2000s, so did the use of “benzos” such as Xanax, Klonopin, and Ativan, as opioid users discovered tranquilizers could enhance “the high.” Data provided to the Journal Sentinel and MedPage Today show the drugs are on the upswing again, increasing from 80 million prescriptions in 2006 to 94 million in 2013, according to IMS Health, a drug market research firm.”  (MedPage Today, 2/25/14)  There was a decline, however, of opioid prescriptions in the past several years, with the prescriptions written in 2013 falling to 230 million from 241 million in 2012.  While the latter number is an improvement, it was not as much of a drop-off as many expected given the attention the opioid epidemic has been given in the medical community.  (MedPage Today, 2/26/14)  Further, while the prescription numbers declined in that year, what is not known is whether the pill count (pills in each bottle) also declined.

The CDC research found that, in addition to the increase in the number of prescriptions, the dosages increased as well. “In a 2012 study, Paulozzi and other CDC researchers found that the average size of an oxycodone prescription — the entire amount in the bottle — increased from the equivalent of 923 milligrams of morphine in 2000 to 1,566 milligrams of morphine in 2010. Oxycodone is a commonly prescribed opioid and is the narcotic used in OxyContin. For hydrocodone, the opioid used in Vicodin, the average dose per prescription increased from the equivalent of 170 milligrams of morphine in 2000 to 288 milligrams in 2010.”   Given the fact that we cannot be certain of dosage and pill count amounts, we cannot be certain that Americans are actually consuming less opioid amounts.  And, if Americans are consuming less opioids, are they now consuming an illegal substitute drug:  heroin.  Between 2008 and 2013, heroin seizures jumped 324% on the Mexican border.

Many of the overdoses are accidental. Patients are often prescribed powerful medications by doctors and then left to cope with their chronic pain and other problems without medical supervision. Benzodiazepines, like Xanax, Librium, Valium and other less commonly known drugs are prescribed for anxiety, depression, panic attacks and other conditions. Panic and anxiety issues may be compounded by other physical and emotional conditions that are not addressed by medications. The lack medical follow-up may leave patients isolated and at risk of over-medicating.

As we regularly see in cases of drugs being widely promoted and prescribed off label, there have been  and are strong ties between the medical profession and the drug manufacturers.  It is, indeed, a natural nexus.  The cooperation between the two dates back to the 1950s when pharmaceutical companies targeted the medical profession with ads in prominent medical journals touting the benefits of opioids for chronic back pain. As recently as 2009 the American Psychiatric Association set out practice guidelines for treating panic disorder, which included a strong recommendation for benzodiazepines.  “Five of the seven doctors on that panel, including its chairman, worked as speakers or consultants to drug companies that sold benzodiazepines in the 3 years prior to the publishing of the guideline, according to disclosure statements issued with the document.” (MedPage Today, 2/25/14)

How much of a problem is this toxic mix? In a story about a 48-year-old woman who died of an accidental overdose in 2012, the report showed that she was able to obtain 4 prescriptions in the month prior to her death. She was already taking oxycodone for chronic back pain, resulting from back surgery some years earlier.  She was prescribed a total of 240 pills of a generic Xanax. At the time of her death, all of the bottles were empty.

We should expect our health care professionals to recognize signs of drug abuse (and the vast majority do), to know our medication history and the potential for harmful drug interactions.  Reducing addiction and dependency on strong opioids and benzodiazepines ideally would include the participation of the FDA,  medical professionals, medical associations,  the drug manufacturers and the patients.  Are we likely to see this level of cooperation, when so much money is at stake?  Hopefully, but in the interim, patients should be fully educated and informed on how dangerous these combinations of drugs can be.

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