Benzos and Opiates: New Study Reveals Overdose Risk
A new study published online in the British Medical Journal revealed that a fatal overdose is four times more likely when benzodiazepines are taken along with opiates. This is true even for relatively low doses of opiates. The deadly connection between benzos and opiates has been known for some time, and this study is consistent with past research and coroner data. It breaks new ground, however, by identifying how great the risk really can be.
Despite what we know about the interaction of central nervous system depressants such as benzos and opiates, there is still a significant amount of co-prescribing by physicians. In addition to overdose, general polydrug abuse between these two categories is substantial.
About the Study
In the study, 2,400 fatalities were identified among nearly 423,000 opioid-prescribed veterans for the treatment of acute and chronic cancer pain. Benzodiazepines were also prescribed in about 1/4 of the patients. Half of the overdose fatalities occurred in patients who were co-prescribed with benzos and opiates.
For those with a current benzodiazepine prescription versus none, the hazard ratio was 3.86, or nearly 4 times the risk. Also, the risk of drug overdose fatality increased as the daily dose of benzodiazepines increased.
What Should Be Done
Physicians should be more alert to the risks of prescribing these medications together, and what they are prescribing them for. For example, benzos are anti-anxiety medications which also treat insomnia. And these disorders are commonly co-occurring with pain. But is the end result really worth the risk?
Moreover, if the goal of drug therapy is to ensure that the quality of life carries more weight than the risk, co-prescribing benzos and opiates may not meet that standard. Especially when death is a real possibility – even withdrawals from benzos can be life-threatening.
The risks and benefits of this polydrug combination should be carefully weighed for each patient.
Risk Factors include:
- High doses of either drug
- A history of mental illness
- A history of substance abuse
- Multiple prescribers of medications (doctor shopping)
For anxiety, SSRIs, such as Zoloft and Paxil, are much safer. Used in conjunction with cognitive-behavioral therapy, these two treatments may succeed at decreasing both anxiety and insomnia. Tetracyclic antidepressants, such as mirtazapine, can also be used for sleep difficulties.