Sunday, February 21, 2016

Overdose Deaths from Common Sedatives Have Surged, New Study Finds

 Newswise, February 21, 2016--Headlines about America’s worsening drug epidemic have focused on deaths from opioids—heroin and prescription painkillers such as OxyContin.

But overdose deaths have also soared among the millions of Americans using benzodiazepine drugs, a class of sedatives that includes Xanax, Valium, and Klonopin, according to a study led by researchers at Albert Einstein College of MedicineMontefiore Health System and the Perelman School of Medicine at University of Pennsylvania. Their findings appear online today in the American Journal of Public Health.

“We found that the death rate from overdoses involving benzodiazepines, also known as ‘benzos,’ has increased more than four-fold since 1996—a public health problem that has gone under the radar,” said lead author Marcus Bachhuber, M.D., MS., assistant professor of medicine at Einstein and attending physician, internal medicine at Montefiore. 

“Overdoses from benzodiazepines have increased at a much faster rate than prescriptions for the drugs, indicating that people have been taking them in a riskier way over time.”

An estimated 1 in 20 U.S. adults fills a benzodiazepine prescription during the course of a year. The drugs are prescribed for conditions including anxiety, mood disorders and insomnia.

In 2013, benzodiazepine overdoses accounted for 31 percent of the nearly 23,000 deaths from prescription drug overdoses in the U.S. But little was known about the national trends in benzodiazepine prescribing or in fatalities from the drugs. To find out, the researchers examined data for the years 1996-2013 from two sources:

•The Medical Expenditure Panel Survey. This federally sponsored survey includes a nationally representative sample of families and individuals who provide information about healthcare purchases including prescription drugs.
•Multiple-cause-of-death data from the Centers for Disease Control and Prevention. The researchers extracted reports from physicians, medical examiners or coroners on all overdose deaths involving a benzodiazepine, including deaths also involving other medications, alcohol or illicit drugs.

Their analysis revealed that the number of adults purchasing a benzodiazepine prescription increased by 67 percent over the 18-year period, from 8.1 million prescriptions in 1996 to 13.5 million in 2013.

 For those obtaining benzodiazepine prescriptions, the average quantity filled during the year more than doubled between 1996 and 2013. Most crucially, the overdose death rate over the 18-year period increased from 0.58 deaths per 100,000 adults in 1996 to 3.14 deaths per 100,000 adults in 2013, a more than four-fold increase.

Overall, the rate of overdose deaths from benzodiazepines has leveled off since 2010. But for a few groups—adults aged 65 and over and for blacks and Hispanics—the rate of overdose deaths after 2010 continued to rise.

“The greater quantity of benzodiazepines prescribed to patients—more than doubling over the time period—suggests a higher daily dose or more days of treatment, either of which could increase the risk of fatal overdose,” said senior author Joanna Starrels, M.D., M.S., associate professor of medicine at Einstein and attending physician, internal medicine at Montefiore.

Dr. Starrels also offered two other possible reasons for the spike in benzodiazepine deaths. “People at high risk for fatal overdose may be obtaining diverted benzodiazepines [i.e., not from medical providers], and we know that combining benzodiazepines with alcohol or drugs—including opioid painkillers—can lead to fatal overdoses,” she said.

She noted that opioid prescribing has increased rapidly during most of the period covered in her study and that opioids are involved in 75 percent of overdose deaths involving benzodiazepines.

“An obvious way to improve benzodiazepine safety would be for people to reduce their use of these medicines,” said study co-author Chinazo Cunningham, M.D., M.S., professor of medicine and of family and social medicine at Einstein and associate chief of the division of general internal medicine at Einstein and Montefiore.

“But we should also be emphasizing the danger of fatal overdose from taking benzodiazepines concurrently with opioid painkillers or with alcohol.”

“This epidemic is almost entirely preventable, as the most common reason to use benzodiazepines is anxiety—which can be treated effectively and much more safely with talk therapy,” said Sean Hennessy, Pharm.D., Ph.D., professor of epidemiology at Penn’s Perelman School of Medicine and co-author of the study.

“Given the high prevalence of anxiety symptoms, we need a more constructive approach to the problem than popping pills.”

The study is titled “Increasing benzodiazepine prescription and overdose mortality in the United States, 1996-2013.” The research was supported by the National Institutes of Health (NIH K24DA036955, R25DA023021 and K23DA027719). The authors report no conflicts of interest.

Wednesday, February 10, 2016

Marijuana Use Now Could Pose Verbal Memory Risk Later

Marijuana smoking can cause verbal memory risk later in life
Newswise, February 10, 2016 — Marijuana is the most frequently used illicit drug in the United States, according to a recent survey from the National Survey on Drug Use and Health, and new data suggest that marijuana use now could pose a serious cognitive function risk later in life.

Stefan Kertesz, M.D., an associate professor with the University of Alabama at Birmingham School of Medicine, is part of a recently published nationwide study reporting potential long-term consequences with implications for public health.

Impaired cognitive functioning is an acute effect of marijuana use, and there is increasing evidence that such effects may persist later in life after marijuana use has ceased. Heavy, long-term use of marijuana has been associated with cognitive impairment, particularly in learning and remembering new information.

Kertesz and other researchers found past exposure to marijuana use to be significantly associated with worse verbal memory in middle age.
Their paper used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study which started in 1985, where more than 5,000 healthy adults were regularly asked about marijuana use. 

In contrast to studies that focus on people known to have an addiction, this study focused on community-based adults, where casual use tends to be more common than addiction.

In the final year of the study, CARDIA participants underwent simple cognitive tests, including a word memory test. Individuals were presented with 15 words and then asked to try to remember them. After 25 minutes, they were later asked to recall the words. 

The tests showed that there was a significant decline in verbal memory among persons whose cumulative marijuana use exceeded the equivalent of one joint a day for five years.
“For every five years of marijuana exposure, one out of two participants would remember one word less,” Kertesz said.

Kertesz also said that it is important to realize that marijuana is more potent today than it was in the 1980s, raising the possibility that users of today’s marijuana may face cognitive consequences of greater magnitude than those reported.

“It’s crucial to recognize that young brains are truly different and not fully developed until age 22 and are at more risk from marijuana,” he said. 

“Parents and teachers need to be vigilant that this poses a larger risk to adolescents.”

Data from 2012 indicates that, among students in the 12th grade (ages 17-18 years), 37 percent had used marijuana within the last year, 23 percent within the last 30 days and 6.5 percent daily.

Monday, February 1, 2016

Alcohol Withdrawal Adds Challenges to Caring for Critically Ill Patients

Article in Critical Care Nurse provides guidance on identifying, managing and assessing critically ill patients experiencing alcohol withdrawal

Newswise, February 1, 2016 — Alcohol withdrawal adds challenges to caring for critically ill patients, and nurses must be diligent at each stage of care to minimize complications, according to an article in the February issue of Critical Care Nurse (CCN).

The article, “Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management,” provides much-needed guidance to critical care nurses and other clinicians whose patients may have alcohol use disorder (AUD), including abuse and dependency conditions of varying severity.

Lead author Lynsey Sutton, RN, MNclin, is associate charge nurse manager of a level 3 intensive care unit, Capital and Coast District Health Board, Wellington Regional Hospital, Wellington, New Zealand. She is a guest teaching assistant in the postgraduate nursing program at Victoria University of Wellington, Wellington, New Zealand.

“The abrupt cessation of alcohol places patients with an AUD at risk for additional complications, and nurses are perfectly placed at the bedside to obtain histories of alcohol consumption from patients or the patients’ families. This may help identify those at risk for withdrawal early,” she said.

For the study, the researchers reviewed more than 100 articles related to alcohol use and critically ill patients that had been published in peer-reviewed journals.

Their work can help frontline nurses who are caring for critically ill patients at risk for alcohol withdrawal syndrome (AWS).

Managing alcohol withdrawal effectively begins with the identification of patients with an AUD as indicated by the patients’ medical histories. 

Unfortunately, a patient’s history of alcohol consumption is often poorly obtained, not detailed enough or not obtained at all.

The researchers recommend that a validated tool be developed to enable nurses to obtain a more comprehensive history of alcohol use, including past withdrawal or detoxification episodes.

If patients at risk are identified at the time of admission, nurses will be better able to detect signs and symptoms of alcohol withdrawal and initiate treatment early. This practice might halt the progression from mild to severe withdrawal and prevent delirium tremens.

The researchers also suggest development of a laboratory test or biomarker to highlight chronic alcohol use, especially when an alcohol history is unobtainable. Current blood tests focus on recent alcohol consumption, which may not help identify those at risk for withdrawal.

“The clinical manifestations of critical illness and alcohol withdrawal are often similar, and a worsening clinical condition in a patient with AWS should not always be assumed to be withdrawal related,” Sutton said.

The article also discusses various therapies, tools and assessment scales nurses can use to evaluate and monitor response to treatment.

The researchers call for further studies related to nearly every aspect of alcohol withdrawal in critically ill patients to help validate tools and develop evidence-based practice guidelines.
As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for high acuity, progressive and critical care nurses, CCN is a trusted source for information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high acuity, progressive and critical care settings. CCN enjoys a circulation of more than 106,000 and can be accessed at
About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than 500,000 acute and critical care nurses and includes more than 225 chapters worldwide. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution.;;