A Growing Threat: Increasing Number of Benzodiazepine Prescriptions in the US

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Opioids are not the only class of drugs that cause a danger to human health; benzodiazepines are a growing threat.
Opioids are not the only class of drugs that cause a danger to human health; benzodiazepines are a growing threat.

Opioids are not the only class of drugs that constitute a danger to human health; overprescription, overuse, and addiction to benzodiazepines is a growing threat, according to an opinion piece published the New England Journal of Medicine.

Anna Lembke, MD, of the department of psychiatry and behavioral sciences at Stanford University School of Medicine in Stanford, California, and colleagues note that between 1996 and 2013, the number of benzodiazepine prescriptions filled by adults increased by 67%. Similarly, the quantity of benzodiazepines in each prescription more than tripled, from 1.1 kg to 3.6 kg lorazepam-equivalents per 100,000 adults.

Overdose deaths involving benzodiazepines increased from 1135 to 8791 between 1999 and 2015. Yet despite this trend, benzodiazepine overuse, misuse, and addiction remains largely unnoticed. The authors believe that this may be the result of the nature of benzodiazepine deaths: 75% of deaths involving benzodiazepines also involve an opioid. In August 2016, the US Food and Drug Administration issued a black box warning regarding the dangers of concomitant use of benzodiazepines and opioids.

Alarmingly, highly potent new forms of benzodiazepines are entering the illicit market. These drugs cannot be distinguished from prescription benzodiazepines and may be as lethal as the synthetic opioid analog fentanyl. “Overprescribing of benzodiazepines may be fueling the use of illicit analogs, just as overprescribing of opioids has fueled increases in heroin and illicit fentanyl use,” the authors wrote.  

Although benzodiazepines have proven benefits when used intermittently and for less than 1 month at a time, the benefits of these drugs diminish and their risks increase with daily use over extended periods. The authors note that many prescribers do not realize that benzodiazepines can be addictive and that when taken daily they may worsen anxiety, contribute to persistent insomnia, and result in death. Other adverse risks associated with benzodiazepines include cognitive decline, accidental injury, falls, and increased rates of hospital admission and emergency department visits.

The authors argue for the need to increase awareness in the media and among clinicians, policy makers, and educators about the problem of overprescribing and overuse of benzodiazepines and Z-drugs (zolpidem, zopiclone, and zaleplon).

“[P]rescribers could be encouraged or required to check their states prescription drug monitoring program (PDMP) before prescribing benzodiazepines, as is often required with opioids,” Dr Lembke and colleagues concluded. “Though their quality and usability vary, PDMPs are now available in every state.” Requiring physicians to consult the PDMP before prescribing opioids has been shown to reduce opioid prescribing, doctor shopping, and overdose deaths related to prescription opioids. The authors suggest that the infrastructure created to address the opioid epidemic should be harnessed to respond to dangerous trends in benzodiazepine overuse, misuse, and addiction as well.

Reference

Lembke A, Papac J, Humphreys K. Our other prescription drug problem. N Engl J Med. 2018;378;8:693-695.

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