Benzodiazepines and Opioids: A Deadly Combination
Reducing Gaps in Information is Key to Treatment Success
The latest statistics from the CDC indicate 63,632 Americans died in 2016 from drug overdose, 66% of which were related to opioids.1 Of those, JAMA reports an estimated 30% occurred while patients were also using benzodiazepines.2 This, unfortunately, is not surprising as the risk of an overdose within the first 90 days of concurrent use is five times that of opioid use alone.2
The number of patients prescribed both an opioid and a benzodiazepine increased 41% between 2002 and 2014 to more than 2.5 million.3 The deadly combination is especially troublesome for Medicare patients; one-fourth receive prescriptions for both drugs at the same time.4
The National Institute on Drug Abuse states “Combining opioids and benzodiazepines can be unsafe because both types of drug sedate users and suppress breathing—the cause of overdose fatality—in addition to impairing cognitive functions.”5 Using these drugs simultaneously leads to more ER visits and hospital admissions for opioid overdose. Today, both drugs carry a warning label indicating the potential dangers.
Information Gaps
Why are these drugs prescribed together? In many cases, the prescribing providers just don’t know about the potential interaction. In other cases, the patient may receive the prescriptions from different clinicians. For example, an orthopedic surgeon may prescribe an opiate-like Vicodin to relieve post-surgery pain for a knee-replacement patient, unaware that the patient takes a benzodiazepine like Xanax for anxiety.
Patients themselves may knowingly hide the fact he’s taking his wife’s prescription opioid or that he’s buying it off the street. In other cases, he/she may simply forget.
What Providers Can Do
The first step providers should take is simply asking patients what other drugs they’re taking. Although some may not be forthcoming, you won’t know unless you ask. Have appointment reminders include a request to bring a list of drugs currently taken. Even better, have the patient bring in their prescription bottles to ensure the accuracy of both the drug name and dosage.
Another important step is checking a prescription database to identify contraindicated drugs. These databases are readily available, easy to use, and updated with the current information and warnings.
Special Consideration for Substance Abuse Disorder Patients
Many physicians have a “don’t ask, don’t tell” policy when treating addiction. While understandable in terms of patient privacy, this approach can further exacerbate gaps in information among the care team. This can be particularly dangerous for these patients. For example, benzodiazepines can enhance the effect of opioids.6 When prescribed both, the chance of relapse could be exponentially higher.
One option for providers treating substance abuse is the A-CHESS Platform for relapse prevention and care coordination. The A-CHESS Platform provides patients continuous access to the support they need to succeed, right on their smartphone, with the Connections App.
With the A-CHESS Platform, the entire care team has the ability to monitor medications and compliance. With the Connections App, peer specialists and caregivers can send timely information to the patient, such as messaging around the dangers of taking opioids and benzodiazepines, information most patients would likely not know. With A-CHESS, patients also have the ability to contact a therapist or other caregiver 24 hours a day, 7 days a week from any location.
Of all components of the A-CHESS app, patients like the BEACON button best, finding it extremely helpful. The BEACON button provides patients the help they need when presented with urges, including immediate access to their predetermined “motivations,” emergency and agency contacts, and a customizable helpline. The care team is alerted when the participant presses the BEACON button, so action can be taken to get the appropriate care to the patient quickly.
Success Begins with Knowledge
Patients facing substance abuse or chronic illnesses rely on their providers to deliver the best care possible, including appropriate medication therapy. This requires providers to have the latest information on prescriptions and potential deadly interactions, such as with benzodiazepines and opioids. Tools such as the A-CHESS Platform and Connections App can help close gaps in information, enhance care collaboration, and improve outcomes for all patients.
Sources
1 https://www.cdc.gov/media/releases/2018/p0329-drug-overdose-deaths.html
2 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2685628
3 https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm518697.htm
4 https://www.psychcongress.com/article/opioid-overdose-risk-5-times-higher-benzodiazepines
5 https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids
6 https://americanaddictioncenters.org/prescription-drugs/dangers-of-mixing/
