The number of people who died from drug overdoses involving anti-anxiety drugs called benzodiazepines increased drastically for more than a decade before leveling off in 2010, according to a new study.
In 2013, the final year of the study, more than 22,700 people died from prescription drug overdoses. Benzodiazepines were involved in about 31 percent of those cases, around 7,000 deaths, according to the Centers for Disease Control and Prevention.
“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,” Dr. Marcus Bachhuber, the lead author of the study, said in a press release. “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.”
The number of American adults who filled a benzo prescription in a year increased from 4.1 percent in 1996 to 5.6 percent in 2013. However, the number of pills prescribed by doctors more than tripled. Death rates grew from 0.58 per 100,000 people in 1996 to 3.07 per 100,000 people in 2013, according to the study.
“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 Dr. Joanna Starrels in a press release.
The researchers examined data from the Medical Expenditure Panel Survey and the CDC. The total number of people who filled a prescription grew from 8.1 million to 13.5 million during the study’s time period. The data included deaths that doctors, medical examiners and coroners declared an overdose that involved benzos.
“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,” Dr. Sean Hennessy, a co-author of the study, said in a press release. “Given the high prevalence of anxiety symptoms, we need a more constructive approach to the problem than popping pills.”
Searching for a Cause
The researchers of the study hypothesized that overdose death rates could have increased for a variety of reasons.
- More prescriptions were filled, and prescriptions were filled for higher doses.
- People with a high risk for overdose may have obtained benzos illegally.
- Opioid prescriptions drastically increased during the same time period, and the combination of opioids and benzodiazepines drastically increases the risk of overdose. About 75 percent of deaths involving benzodiazepines also involve opioids.
Overall, the overdose death rate in the U.S. stabilized after 2010, but the rate continued to increase for people older than 64, for people who identify as black and for people who identify as Hispanic, according to the study.
Health Officials Petition for Black Box Warnings
Health officials from across the county have petitioned the U.S. Food and Drug Administration to add black box warnings to the labels on opioid and benzodiazepine medications. A total of 41 officials from health departments and universities signed the petition in February.
The proposed warnings would caution that combining the drugs “reduces the margin of safety for respiratory depression and contributes to the risk of fatal overdose, particularly in the setting of misuse,” according to the petition.
The officials hope that the proposed labels would prevent doctors from prescribing the medications together. Doctors may prescribe opioids to treat pain and benzos to treat muscle spasms in the same patient, or a patient could receive a benzo prescription for anxiety from a therapist and an opioid prescription for pain from another doctor.
“The science clearly demonstrates that this is a potentially fatal combination, when opioids and benzodiazepines are prescribed together,” Nicole Alexander-Scott, director of Rhode Island’s Department of Health, told the Washington Post.
The FDA issued a statement saying it was “committed to working with the health care community and our federal, state and local partners to help reduce opioid and benzodiazepine misuse and abuse.”