FDA Makes It Perfectly Clear: Opioids, Benzodiazepines a Deadly Mix

Pain and anxiety often go hand in hand. Unfortunately, the medications used to relieve them should not.

That’s why the U.S. Food and Drug Administration recently mandated sweeping changes to the warning labels of opioid painkillers and anxiety medications, also known as central nervous system depressants. The FDA now requires box warnings, the most serious level of caution, for a staggering 400 medications and products.

The boxes will warn of “extreme sleepiness, respiratory depression, coma, and death,” according to an FDA news release.1

“It is nothing short of a public health crisis when you see a substantial increase of avoidable overdose and death related to two widely used drug classes being taken together,” FDA Commissioner Dr. Robert Califf said. “We implore healthcare professionals to heed these new warnings and more carefully and thoroughly evaluate, on a patient-by-patient basis, whether the benefits of using opioids and benzodiazepines – or CNS depressants more generally – together outweigh these serious risks.”

Some common examples of benzodiazepines include drugs like Xanax, Ativan, Klonopin, and Valium. In addition to being prescribed for anxiety, doctors also write scripts for central nervous system depressants to treat seizures and insomnia. Common opioid painkillers include oxycodone, hydrocodone, and morphine.

The FDA also is investigating the potential risks of mixing benzodiazepines with medication-assisted opioid replacement therapies, such as Suboxone, which are often used to treat opioid dependence.

The FDA reports that between 2004 and 2011, trips to the emergency room involving both classes of drugs skyrocketed. Overdose deaths – including overdose deaths by people taking prescribed doses – nearly tripled in that period. And the number of patients being prescribed both classes of drugs increased by 41 percent, meaning 2.5 million people being prescribed opioid painkillers also were being prescribed benzodiazepines.
Image displaying the data of emergency trips involving prescribed opioid painkillers between 2004 and 2011In a research letter published in 2013 in JAMA, opioids accounted for the most overdose deaths (75 percent) followed by benzodiazepines (30 percent) either separately or in combination. The research also showed that in more than 77 percent of the overdose deaths blamed primarily on benzodiazepines, opioids also were involved.2

In an inspiring story told on the recovery community website Heroes In Recovery, David Loffert explains how combinations of prescription drugs nearly took his life several times. He was prescribed the drugs by a doctor while in medical school to help him maximize his academic performance, he wrote.

“In a time frame of eight months, I was prescribed 6,647 controlled substance pills,” he said. “I had pills to help me stay awake and study, pills for helping me sleep, pills for anxiety, and pills for pain. I knew about addiction, but I thought I was too intelligent to become addicted … My ignorance would cause me to lose almost a decade of my life.”

But Loffert did recover, and is the author of the autobiography, “From Hopkins to Homeless: My True Story of Prescription Drug Addiction.”

In another piece on the Heroes in Recovery website titled “I Should Be Dead,” Angela L. describes a similar path that began with prescriptions from her doctor.

“When I got pregnant with my daughter, my back (pain) was increasingly worse. I was prescribed and was talking 10 mg hydrocodone, then oxycodone up to four times a day as needed,” Angela wrote. “After she was born, an MRI was done and three herniated discs, arthritis, degenerative disc disease, and sciatica were just a few of the issues they diagnosed.”

All cripplingly painful conditions, the doctors ramped up the opioid medications. “For my extreme anxiety and sleep issues, I was on 4-6 mg of Xanax daily…on top of these I was given Soma, Neurontin and Lyrica,” Angela continues. “To summarize as best I can: I should be dead at least five times now.”

Finally, Angela got the help she needed because she not only wanted to get well, but she also decided that she deserved to get well.

“I didn’t EVER ask or take help from anyone my entire life,” she said. “When I was able to let myself acknowledge my need and admit my helplessness, my life was saved. Love yourself enough to LIVE.”

Written by David Heitz

1 U.S. Food and Drug Administration. (31 Aug. 2016). FDA requires strong warnings for opioid analgesics, prescription opioid cough products, and benzodiazepine labeling related to serious risks and death from combined use. Retrieved Nov. 1, 2016, from fda.gov
2 Jones, C. et al. (2013, Feb. 20). Pharmaceutical Overdose Deaths, United States, 2010. JAMA. Retrieved Nov. 1, 2016, from jamanetwork.com

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