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Deaths Linked To Anti-Anxiety Drugs Rise, But Fly Under The Radar

Packages of the anti-anxiety drug Lorazepam are shown, Feb. 15, 2018.

Credit: Kenny Goldberg

Above: Packages of the anti-anxiety drug Lorazepam are shown, Feb. 15, 2018.

Valium and Xanax are in the class of drugs known as benzodiazepines.

These medications help control anxiety, panic attacks and insomnia.

But doctors say they are habit-forming and have some dangerous side effects.

Dr. Roneet Lev, director of the emergency department at Scripps Mercy Hospital in San Diego, often sees the downsides of benzodiazepines.

"That comes from people who come into our trauma center from car accidents because they’re on benzodiazepines, people who come in because they’re falling down, because that affects their balance and coordination on benzodiazepines," she said. "We’ve seen terrible withdrawls, when they’re used to having it, with seizures, that end up in the ICU.”

Lev said when it comes to drug-related deaths in San Diego County, benzodiazepines are right behind opioids.

“Number one prescribed drug associated with death is oxycodone, then hydrocodone, the number three, benzodiazepine," she said.

Nicholas Mcvicker,

Deaths involving benzodiazepines quadrupled

Nationwide between 2002 and 2015, according to the National Institute On Drug Abuse, the number of deaths involving benzodiazepines more than quadrupled.

Nathan Painter, associate professor at UC San Diego Skaggs School of Pharmacy, said these drugs can be risky. And when taken in combination with opioid painkillers, deadly.

“The benzodiazepines themselves can cause respiratory depression, or your breathing slow down, and so can opioids," Painter said. "So when you combine them, especially in the case of not using them on a regular basis, or being new to the benzo or the opioid, if you give too much, or combine it with other things like alcohol or other medications, then it can cause that breathing to slow down, or even stop.”

Benzodiazepines, opioids a lethal mix

The San Diego County Medical Examiner found that 83 percent of the people who suffered a benzodiazepine-related death in 2016, also had an opioid in their system.

Photo credit: Kenny Goldberg

Packages of the drug chlordiazepoxide, also known as Librium, are shown, Feb. 15, 2018.

Painter said even when taken as directed, benzodiazepines and opioids can be a lethal mix.

“Because both drugs of them independently can cause problems, and a lot of times, the physicians that are prescribing them aren’t necessarily aware of all the drugs that are onboard, and may not be as conservative or as slow in starting the medicines as without that knowledge,” he said.

The Veterans Association Healthcare System is trying to address these problems.

Dr. James Michelsen, a specialist in internal medicine and chair of the San Diego VA’s pain council, said many veterans have conditions that would typically call for both a benzodiazepine and an opioid.

“Anxiety related to their combat time, problems with sleep, post-traumatic stress disorder. And traditionally these conditions benzodiazepines have been used to treat," he said. "Additionally, many of our veterans came back with physical wounds, as well.”

A warning pops up

But Dr. Michelsen said the VA is aware of the dangers and is making a concerted effort to scale back the co-prescribing of opioids and benzodiazepines.

For example, if a patient is already taking an opioid, and their doctor wants to add a benzodiazapine to the mix, a warning pops up on the computer doctors use to write prescriptions.

Michelsen said over the past two years, the VA has made a 40 percent reduction in the number of co-prescriptions.

He said the VA is also targeting benzodiazapines on their own.

“Ten years ago, the thought was benzodiazepines could help quite a bit with symptoms," he said. "And they do in the short run, people feel better when they take it, they get a temporary relief. But in the long run, the benzodiazepines turn out to not help the condition very much, and potentially can even be harmful. But now we have quite a few patients on benzodiazepines, and we have to start reeling those prescriptions back.”

But the VA is facing a big challenge: 70 percent of their patients also get care from outside doctors.

Scripps Mercy’s Roneet Lev believes the way to reduce benzodiazepine-related problems is to set up a barrier to prescribing them.

“And by that, I mean health plans and government paying for these medications. If they put stricter controls, then we would have less access," she said.

But that wouldn’t be easy.

Benzodiazepines are among the most widely prescribed drugs in the U.S. And according to the San Diego County Prescription Drug Abuse Task Force, there’s no shortage of them in our region.

The Task Force found in 2016, local pharmacists sold more than 37 million benzodiazepines.

Valium and Xanax are in the class of drugs known as benzodiazepines. These medications help control anxiety, panic attacks and insomnia. But doctors say they are habit-forming and have some dangerous side effects.

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