A new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) has found that the risk of severe adverse outcomes associated with benzodiazepines is sharply increased when those medications are combined with opioid pain relievers and/or alcohol.
The report, Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious Emergency Department Visit Outcomes, examined benzodiazepine-related emergency room visits between 2005 and 2011 that were reported as part of the Drug Abuse Warning Network (DAWN), a national hospital program that gathers data on drug-related illness and injury.
Half of ER visits related to combining benzodiazepines, such as alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin), and lorazepam (Ativan), with alcohol and opioids resulted in serious medical outcomes, including death. This compared to 32% of ER visits related to benzodiazepines alone resulting in serious outcomes. For both benzos + opioids and benzos + alcohol, the risk of serious health outcomes was 44%.
The risk was even greater for the elderly: 70% of ER visits for the three-substance combination led to serious outcomes for people over age 65. This information comes at the same time as a JAMA report that benzodiazepine prescribing increases with age, and that close to 9% of people over 65 have been prescribed a benzodiazepine, often for long-term use. This is despite a known increase in the risks of benzos for this age group.
In analyzing the data, researchers excluded suicide attempts and ER visits in which people were seeking drug detox. They also excluded patients who were taking any drugs other than benzodiazepines and opioids.
While these parameters may have greatly reduced the number of people who were not taking therapeutic/prescribed doses of the medications studied, “not all visits involving benzodiazepines combined with opioids are a result of prescribing practices,” says the report. “Sometimes patients take more than the prescribed dose of a medication, either because they perceive that the prescribed dose is not effective in controlling their symptoms or because they enjoy the effects of larger doses.”
Benzodiazepines, opioids, and alcohol are all central nervous system depressants, decreasing brain activity and leading to calming effects. When benzodiazepines are prescribed along with pain medications, the CNS depressing effects can be amplified. Add a few drinks to the mix, and the combination can become very risky, leading to confusion and dangerous decreases in heart rate and respiration.
The report’s take-away message is that prescribers need to be diligent in making prescribing decisions and communicating risks to their patients.
For more information, see the SAMHSA website.
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