In April of 2014, Richard D. Lewis posted “Opiates and benzos: A deadly cocktail of drugs” on southcoasttoday.com. South Coast is the southern coastal region of Massachusetts. The article showed clearly that it is benzodiazepines combined with opioids, not
opioids alone, that are causing many overdose deaths.
Mr. Lewis updated that article in an August 2 post, again on southcoasttoday.com, pointing out that ignoring benzodiazepine prescribing has led to a “perfect storm”.
“Heroin, along with the over-prescription of other opiates, seems to gather all the publicity and attention related to the opiate epidemic,” he wrote. “Benzos, however, appear to fly under the radar with no area doctors or public officials willing to focus attention on this enormous elephant in the room.”
Both opioids and benzodiazepines are central nervous system depressants. Combined, they can cause serious problems. “Where are all the storm alerts regarding the role of benzos in the opioid drug overdose crisis?” Mr. Lewis asked.
He charged that benzodiazepines “are recklessly over-prescribed by psychiatrists and primary care doctors for managing anxiety symptoms and insomnia.”
While both medications are “usually very safe and effective when dispensed in a controlled medical environment,” they shouldn’t be used for more than two to four weeks, due to tolerance and possible addiction problems. Yet, he said, many physicians prescribe them for patients who have addiction histories, and for patients currently taking opioids, including buprenorphine or methadone.
Benzodiazepine treatment also is associated with fractures and falls, higher mortality, and a greater risk of dementia in elderly patients, he added.
Citing recent information in the Boston Globe, Mr. Lewis wrote that one psychiatrist from Fall River, in the heart of South Coast territory, was the fifth-highest prescriber of Xanax in the country in 2013.
Mr. Lewis criticized Gov. Charlie Baker’s recent report on the state’s opioid epidemic for focusing only on opioid overprescribing. (To be fair, the vast majority of federal and state reports on the prescription opioid epidemic have ignored benzodiazepines.)
State Prescription Drug Monitoring Programs (PDMPs) require the reporting of all prescriptions for controlled substances; benzodiazepines are Schedule IV medications, and should be reported. In fact, many physicians supporting PDMPs have emphasized that they want to know if patients are taking methadone or buprenorphine, so that they do not prescribe any medication that could interact with either of these drugs, potentially harming the patient.