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 Medicine, Montefiore 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.
