- The risks of overprescribing and overusing benzodiazepines may be going overlooked amid the ongoing opioid overdose epidemic, cautions a perspective column published Feb. 22 in the New England Journal of Medicine.
- "We believe national efforts to reduce overprescribing of opioids and to educate the medical and lay communities about their risks should be expanded to target benzodiazepines," wrote the three authors, two of whom are affiliated with Stanford University School of Medicine and the third with the Veterans Affairs Palo Alto Health Care System.
- Benzodiazepines, which include drugs like Xanax, Valium and Ativan, are prescribed for a wide range of conditions both on and off label. In 2016, the Food and Drug Administration put a boxed warning on both benzodiazepines and opioids warning of the risk of combining the two types of drugs.
Overdose deaths involving benzodiazepines increased nearly 8-fold over the decade and a half between 1999 and 2015, according to data from the National Institute on Drug Abuse cited by the NEJM commentary.
That this increase has occurred alongside a more rapid and deadly increase in the number of opioid overdoses and deaths has obscured the risks to benzodiazepines, the authors argue.
As a result of the opioid epidemic, greater scrutiny has been placed both upon physician prescribing habits and the drugmakers that market to doctors.
On the former issue, both the Food and Drug Administration and the Centers for Disease Control and Prevention have taken steps to strengthen guidelines around opioid prescribing. The FDA, for example, has expanded Risk Evaluation and Mitigation Strategy (REMS) requirements for immediate-release prescription painkillers among several other policy steps.
The authors of the NEJM commentary suggest that some of those efforts be broadened to include benzodiazepines, particularly around physician education of the risks to prescribing the drugs over long periods of time.
"We believe that the growing infrastructure to address the opioid epidemic should be harnessed to respond to dangerous trends in benzodiazepine overuse, misuse, and addiction as well," they wrote.
Since requiring a black box warning on coprescribing benzodiazepine and opioids in 2016, the FDA has subsequently urged doctors not to withhold opioid addiction medications like methadone for patients currently taking benzodiazepines.
The regulator acknowledged the coprescribing risk but noted the possible harm that could come from untreated opioid addiction more than offset the danger.