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One Simple Way to Reduce Deadly Heroin and Pain Pill Overdoses

Submitted by Phillip Smith on (Issue #966)
Consequences of Prohibition
Drug War Issues

The United States is in the grips of the worst drug overdose crisis ever, with prescription opioids and illicit opiates like heroin killing tens of thousands of people each year, but many of those people aren't dying from opioids alone. Another class of prescription drugs is too often involved.

Those drugs are the benzodiazepines -- with brand names like Valium and Xanax -- and are prescribed by the millions to treat anxiety, They can be deadly on their own, with federal data showing nearly 9,000 fatal benzo ODs in 2015. But here's the kicker: Nearly half of all fatal benzo ODs involve both them and opioids.

And a new study published in the British Medical Journal provides further evidence of the risks of doing benzos and opioids together. That study drew on a sample of more than 300,000 patients continuously enrolled in private health insurance plans between 2001 and 2013, and researchers looked at emergency room visits for drug overdoses among those prescribed only opioids versus those prescribed both opioids and benzos.

The results were dramatic: People prescribed both types of drugs had nearly double the risk of an ER or inpatient visit for a drug overdose. Based on the results, researchers estimated that cutting benzo prescriptions for opioid users reduced the risk of ER visits by 15%. If that figure holds true for overdose deaths, some 2,630 opioid-related overdose deaths could have been prevented in 2015 alone.

The policy implications are clear, said study coauthor and Stanford University drug policy expert Keith Humphreys: Don't prescribe benzos to people being prescribed opioids.

"Even if we didn't change opioid prescribing at all, the data here suggest that we could cut overdoses dramatically just by getting prescribers to not put people on a benzodiazepine at the same time," Humphreys said.

That would require a real shift in prescribing practices. The number of patients in the study being prescribed both benzos and opioids nearly doubled between 2001 and 2013, from 9% to 17%.

Reducing co-prescriptions could be problematic for some patients. If they are suffering both pain and anxiety, they and their doctors will have to work together to decide which issue is most serious and which could be treated with alternatives. But making such tough choices could lead to a reduced risk of fatal overdose.

The BMJ study has its limits. It looked only at legally prescribed benzos and opioids, missing the effects of concurrent use of illicit drugs, and it looked only at ER and inpatient visits, not fatal overdoses. And it only demonstrated correlation, not causation. It's possible some factor other than co-prescribing was driving up overdose rates among study patients, but given that the overdose risks of mixing benzos and opioids are well established, suggesting that co-prescribing them results in increased overdoses is not exactly controversial.

Doctors can do their part to reduce the number of overdose deaths by reducing benzo and opioid co-prescribing, but since much benzo and opioid use occurs outside legal medical channels, users in non-medically supervised settings are also going to have to be keenly aware of the dangers of mixing those drugs. If they are, the evidence suggests they can save some lives.

Permission to Reprint: This content is licensed under a modified Creative Commons Attribution license. Content of a purely educational nature in Drug War Chronicle appear courtesy of DRCNet Foundation, unless otherwise noted.


saynotohypocrisy (not verified)

as far as I can tell. Yet this article makes pretty damn clear to me that the medical profession has been slow to react to the dangers of mxing these 2 classes of drugs.What's wrong with the goddamn leadership of the medical profession? They are being criminally slow to recognize the validity of medical marijuana, most strikingly in connection with this very problem of opiate overdoses. Prescribing cannabis for pain as a substitute or partial substitute for opiates is a no brainer, and so is allowing doctors to prescribe cannabis as part of opiate addiction treatment. How many more lives will go down the drain before they get real?

Thu, 03/30/2017 - 10:57am Permalink

Benzodiazepines are famous for negatively affecting memory. Thus people taking them tend to forget they already took their medications and might well take them again too soon, causing an accidental overdose situation. Providers should insist that patients use a "pill minder" to help prevent these ODs. Simple, and probably quite effective for legitamate patients.A study is urgently needed here... James Stewart Campbell MD Doctor of MEDesign
Sat, 04/01/2017 - 9:55am Permalink

Since when are any benzodiazepines deadly on their own?  I was taught that on their own, they're suicide-proof.  I'm going to have to see something more solid than these death statistics that says one of the drugs of the benzodiazepine class can kill on its own.  Maybe there's been one developed in that class that has some additional action since I studied the subject.


It's long been knows that in combination with other drugs, they could contribute to death, and that under certain circumstances the mental impairment they temporarily cause could lead to death.  It's also long been known that withdrawal from high doses could cause fatal seizures.  But I'd have to see something solid that shows that on their own they have some significant acute or chronic toxicity.  Mere collected death numbers attributed officially to them tells me nothing.  I want to know how they kill, if indeed they do.

Sat, 04/01/2017 - 10:07am Permalink
borden (not verified)

In reply to by Robert Goodman (not verified)

Robert, I don't think the article or the study it reports on claim any toxicity on the part of benzodiazepines on their own. However, I could have missed something, so feel free to correct me here if so. I only saw discussion of a drug interaction.

Sat, 04/01/2017 - 4:29pm Permalink

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