While headlines about drug overdoses focus on opiods, such as heroin and prescription painkillers like OxyContin, a new study has found that overdose deaths have risen four-fold among Americans using common sedatives, like Xanax, Valium, and Klonopin.
“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., an assistant professor of medicine at Albert Einstein College of Medicine.
“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 one in 20 adults in the U.S. 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.
The researchers wanted to know more about national trends in benzodiazepine prescribing or in fatalities from the drugs. That led them to examine data from 1996 to 2013 from two sources.
The first was the Medical Expenditure Panel Survey. A federally sponsored survey, it includes a nationally representative sample of families and individuals who provide information about healthcare purchases, including prescription drugs.
The second was 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 prescriptions, the average quantity filled during the year more than doubled between 1996 and 2013, the analysis discovered.
Most crucially, according to the researchers, 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.
The analysis found that, overall, the rate of overdose deaths from benzodiazepines 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, it found.
“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., an associate professor of medicine at Einstein.
She offered two other possible reasons for the spike in benzodiazepine deaths.
“People at high risk for fatal overdose may be obtaining diverted benzodiazepines — 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 the study, adding 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., a professor of medicine and of family and social medicine at Einstein. “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 co-author Sean Hennessy, Pharm.D., Ph.D., a professor of epidemiology at the Perelman School of Medicine at the University of Pennsylvania.
“Given the high prevalence of anxiety symptoms, we need a more constructive approach to the problem than popping pills.”
The study was published in the American Journal of Public Health.