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Editorial: Benzos add to deadly overdose epidemic

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Friday, January 05, 2018

A revealing report this week in the Daily Hampshire Gazette focused attention on benzodiazepines, a class of prescription drugs whose deadly contribution to the nation’s overdose epidemic largely has been overlooked.

The four-part series was reported by M.J. Tidwell, a member of the Boston University Statehouse Program who worked with the Gazette during the fall semester as part of her master’s degree in journalism studies. We hope that Tidwell’s reporting helps raise awareness about the dangers of the drugs known as benzos and leads to reforms including legislation proposed in Massachusetts that would add warning labels on prescriptions.

“The ‘opioid problem’ is not just an opioid problem,” says Cherry Sullivan, coordinator for Hampshire HOPE, a regional opioid prevention coalition. “It’s in general a challenge we are facing with multiple drugs in our community.

“In this area we’ve been blessed with the media bringing a lot of attention to the opioid crisis here, but it’s more complicated than just opioids.”

While opioids are prescribed to provide relief from pain, benzos such as Xanax, Valium and Klonopin are prescribed for anxiety, panic disorders, seizures and sleeplessness. While medical experts agree that benzos are effective in treating specific, severe symptoms for a short period of time, there is increasing debate about the side effects and withdrawal symptoms when the drugs are used for more than a few weeks.

Mixing them with opioids can be deadly. “It’s the combination of benzos and opioids that are killing people,” says Liz Whynott, director of the Tapestry Health Systems needle exchange program in Northampton.

Benzos were involved in 30 percent of overdoses nationwide between 1996 and 2013, according to a study by the American Journal of Public Health published in 2016.

The U.S. Food and Drug Administration reported that while the number of opioid prescriptions increased by 8 percent between 2002 and 2014, prescriptions for benzos rose by 31 percent during that period. Moreover, the FDA determined that 2.5 million more people were prescribed both an opioid and a benzo in 2014 than in 2002.

The FDA study also found that the number of opioid deaths in which benzos played a role increased from 18 percent in 2002 to 31 percent in 2014.

A Stanford University School of Medicine study in 2017 concluded that the combination of opioids and benzos is particularly dangerous because both act on the central nervous system. Mixing them can slow or halt heart and lung functions.

Whynott points out that some benzos remain active in a person’s system for up to 24 hours. “We need to educate people that when they overdose, it’s not just what they took in the moment. It can be the buildup of other drugs.”

Among the experts sounding the alarm about benzos is Dr. Christy Huff, a Texas cardiologist who was prescribed Xanax after dry-eye syndrome made her eyes “feel like sandpaper,” disrupting her sleep. Two years later she still suffers severe withdrawal symptoms as she tries to taper off the drug. “At first I was blindsided — I had no idea this could happen,” she says. “Still it’s completely unreal and if it didn’t happen to me, I wouldn’t believe it.”

Her concerns prompted Huff to submit testimony urging approval of H3594, a bill under review by the Legislature’s Committee on Mental Health, Substance Abuse and Recovery. It would require written, informed consent from patients acknowledging the risks of dependency and addiction associated with long-term use of benzos, and would require warning labels.

Also troubling is the increasing number of young people who are being prescribed benzos, as well as the growing trend among youths of using them recreationally.

Karen Jarvis-Vance, the director of Health, Safety and Equity programs at Northampton High School, says a focus there is on educating students about the risks of taking drugs for which they do not have a prescription, as well as mixing drugs or taking them with alcohol.

She adds that people of all ages should understand the dangers of drug cocktails. “Certainly, it’s something for people to think about who are working on the opioid epidemic, adding that message in: that mixing other drugs with opioids is really going to increase your chances of accidentally overdosing.”

That warning could be a lifesaver.