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Benzodiazepines: The ‘Other’ American Drug Crisis

By Kathleen DohenyFebruary 22, 2018
From the WebMD Archives

Experts call it ”our other prescription drug problem.”

Like opioids, it can kill and lead to addiction. “It” is benzodiazepine drugs, prescribed to help anxiety and insomnia. While the opioid epidemic has received much attention, the benzodiazepine problem has not, says Anna Lembke, MD, associate professor of psychiatry and chief of addiction medicine at the Stanford University School of Medicine. That needs to change, she says.

Among those who would agree with her: Vicky Cornell, widow of Soundgarden front man Chris Cornell, who died of what medical experts said was an apparent suicide nearly a year ago. Vicky Cornell said on Good Morning America that she blames her husband’s death on the benzodiazepine prescribed to help him sleep while dealing with the pain of a shoulder injury.

In a report in this week’s New England Journal of Medicine, Lembke and two colleagues spell out how bad the benzodiazepine problem is and call for increased education and awareness.

Between 1996 and 2013, the number of U.S. adults filling a benzodiazepine prescription rose by 67%, from 8.1 million to 13.5 million. More than 1,100 people died in 1999 from overdosing on benzodiazepines, which include brand names like Xanax and Valium, but nearly 8,800 died in 2015.

Despite the dangers, rates of prescribing both benzodiazepines and opioids together rose from 9% in 2001 to 17% in 2013. In 2016, the FDA began to require a black box warning on opioids, opioid-containing cough products and benzodiazepines to warn of the risks of using the medications at the same time.

Experts say the medications help when used sparingly and for short periods of time. The risks come when the drugs are used daily and for a month or more at a time.

WebMD asked Lembke to elaborate.

WebMD: What is a benzodiazepine exactly?

Lembke: It’s a class of drugs–such as Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), Valium (diazepam), to name a few–that are commonly prescribed for anxiety and insomnia.

WebMD: Although they are by prescription only, do people tend to think of them as without risk?

Lembke: That’s right. I think people overestimate the benefits and underestimate the risks. Some people will get addicted very quickly, over a matter of days.

WebMD: How do people die from these?

Lembke: What happens is there is a decreased breathing and heart rate, so people fall asleep and don’t wake up again. It’s similar to opioids. And three -quarters of benzodiazepine-related deaths also involve an opioid. Benzodiazepines alone can also kill.

WebMD: In your report, you say highly potent new forms of benzodiazepines are entering the illicit market. Can you elaborate?

Lembke: It’s a really scary new problem. The phenomenon is that people looking for a new high are going online and ordering illicit benzodiazepines, synthesized in illegal laboratories, and having them delivered to their doorsteps. You can order them online as research chemicals. That is what they are marketed as. They are highly potent so even just a small amount, a few micrograms, is enough to kill.

WebMD: What can be done?

Lembke: We have a lot of efforts in place to address the opioid issue. We could tandem on those efforts. [Like opioids] the drugs should be limited to the lowest dose, the shortest duration. Urine screens can be done to be sure the patient is not diverting benzodiazepines (for street sale) or misusing. Importantly, we need to establish clinics, just like to help (users) taper off opioids. A lot (of people) struggle to taper off benzodiazepines. Benzodiazepines are basically alcohol in a pill.

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