Sarastoa, FL (WorkersCompensation.com) A dangerous class of drugs is increasingly being prescribed for back aches and chronic pain. They can cause physical dependence, addiction, overdose and even death. Their effectiveness is questioned. And yet, the rate of prescriptions more than doubled between 2003 and 2015. There’s no doubt about it: something needs to be done about the overprescribing of benzodiazepines.
The Benzo Problem
Originally used as mild tranquilizers, they are prescribed for anxiety, insomnia, epilepsy, muscle spasms, and alcohol withdrawal. They are sold under names such as valium, Ativan, xanax, Librium, klonopin, and restoril.
Experts say they have very limited use today, but are nevertheless overprescribed.
“They are intended for a short duration of therapy,” said Phil Walls, chief Clinical Officer for myMatrixx. “If you refer a patient for an MRI who has claustrophobia, one or two xanax makes sense; but you certainly would not need it ongoing. You can’t make a good case for using it long term or even more than a few days or weeks.”
Research over the last couple of years has highlighted the problem of benzos in combination with opioids. But the drugs themselves carry a host of risks, such as
- Altered cognitive states
- Slower respiration
- Slowing of the central nervous system
- Poor coordination
- Dizziness or drowsiness
They are responsible for many ER visits, and are also associated with falls, motor vehicle accidents and broken bones. “Someone taking these should probably not be driving, operating heavy machinery, or making important decisions,” Walls said.
What makes benzos even more dangerous is the fact that they are often prescribed or taken with other medications. The risks of mixing benzos with opioids have been well documented. But they also should not be used with other types of substances.
“They are also prescribed with stimulants,” Walls said, “like Adderall, Ritalin, amphetamines.”
There is increasing evidence they are also prescribed with sedating medications. And many patients consume alcohol while taking them, according to the study.
The new study, published in the Journal of the American Medical Association, said the rate of benzodiazepine-related overdose deaths “has risen dramatically,” from .6 per 100,000 adults in 1999 to 4.4 in 2016. From 2003 to 2015, the use of the drugs rose from 3.8 percent to 7.4 percent of ambulatory care visits, and included co-prescribing with other sedating medications.”
While prescribing rates among psychiatrists remained fairly stable during the study time period, increased prescribing was seen among all other types of providers, especially primary care physicians. As a group, they accounted for “about half” of the benzodiazepine visits.
“The increase in the number of benzodiazepine visits likely reflects not only a growing number of unique individuals receiving benzodiazepines, but also an increase in those who are receiving benzodiazepines on a long-term basis,” according to the study … “although a modest increase occurred in use for anxiety and unchanged use for insomnia, we found that benzodiazepine use for back and chronic pain as well as undefined indications increased by a much larger degree.”
The researchers speculated that might be associated with the current opioid epidemic. “In particular, these trends could reflect an underappreciation of the risks associated with benzodiazepines and an overappreciation of the benefits, given their rapid therapeutic effects, marketing techniques used by the pharmaceutical industry, greater frequency with which anxiety or other ‘diseases of despair’ are manifesting themselves in presentations to primary care, and poor availability of or access to pharmacologic and nonpharmacologic alternatives.”
So, is this class of drugs the next opioid crisis? “It is,” Walls said. “We still have an opioid problem, but I’m of mindset that they are not the only dangerous drug. By definition, all controlled substances are.”