The Next U.S. Drug Epidemic As of 2019

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The war on drug use and addiction is a huge focus for public health officials right now, with opioids and heroin at the forefront of the fight. But opioids aren’t the only drugs causing health concerns in 2019: benzodiazepines present a growing threat.

Anxiety suffers to benzodiazepenes to manage their feelings

Photo by Kylli Kittus on Unsplash

Benzodiazepine drugs, such as Xanax, Valium, and Klonopin, are commonly prescribed for insomnia and anxiety. Perceived as safe by the general public and many physicians, these medications are now taken by millions of individuals on a long-term basis and together with opioid painkillers. Such widespread use of benzodiazepines creates serious concerns among public health officials, as this type of drug is only meant for short-time use and should not be combined with opioids.

While they might be quite harmless when administered alone and for a short period of time, benzodiazepines pack some serious health dangers for patients who abuse them. For example, prolonged use of benzodiazepines puts individuals at risk of dependence; combining them with opioid drugs increases the chances of a fatal overdose.

Observing an increase in benzodiazepine abuse, public health officials are working to draw heightened attention to drug prescription and administration protocols.

Alarming Statistics on Benzodiazepine Use

  • According to the New England Journal of Medicine, between 1996 and 2013, the number of individuals using benzodiazepine drugs increased from eight million to almost 14 million. Although medical professionals are aware of the contraindications of combining painkillers with anti-anxiety drugs, combined prescriptions were given out twice as often between 2001 and 2013.
  • As reported by Montefiore Medical Center, a rise in the number of overdose deaths coincided with increased benzodiazepine prescriptions. From 2002 to 2015, fatal outcomes from overdosing on benzodiazepines quadrupled, according to the National Institute on Drug Abuse (NIDA).
  • The Centers for Disease Control and Prevention (CDC) reported that more than 30 percent of deaths from opioid overdose between 2010 and 2014 also involved benzodiazepines.
  • NIDA warns that individuals are 10 times more likely to die from an overdose when taking benzodiazepines with painkillers. In addition, benzodiazepine users may suffer strong withdrawal symptoms for months and even years after discontinuation. Sudden discontinuation of benzodiazepine drugs could cause seizures and even death.

 

The Origins of Benzodiazepines

Discovered by Leo Sternbach, benzodiazepines first appeared on the market in 1960, with the emergence of modern psychopharmacology. Due to their hypnotic, sedative, muscle-relaxant, anxiolytic, anticonvulsant properties as well as tolerability and ease of use, these drugs quickly became popular and have been used by psychiatrists to treat insomnia, anxiety disorders, and alcohol withdrawals.

Fast forward to modern times… anxiety issues are discussed more openly today than they were in the past, and Americans’ anxiety levels seem to be on the rise. According to the American Psychiatric Association’s Public Opinion Poll at its 2017 annual meeting, 36% of respondents felt more anxious than they had been at the same time a year ago, while only 20% felt less anxious.

With more of these drugs being prescribed and making it to the streets, overdoses involving benzos are growing. According to the Centers for Disease Control and Prevention, the crude drug overdose death rate increased 260% just among women age 30-64 years between 1999 and 2017. During this time, drug overdose deaths involving benzodiazepines rose 830%. Only opioids and heroin saw greater increases, at 1,643% and 915% respectively. Among all ages, drug overdose deaths involving benzodiazepines by opioid involvement increased from 1,135 in 1999 to 11,537 in 2017, as reported by the CDC.

Observing some familiar disturbing patterns with benzodiazepines, Dr. Anna Lembke, a researcher and addiction specialist at Stanford University, recalls the opioid crisis in the 1990s: “It really does begin with overprescribing. Liberal therapeutic use of drugs in a medical setting tends to normalize their use. People start to think they’re safe and, because they make them feel good, it doesn’t matter where they get them or how many they use.”

Besides being generously used and combined with painkillers, modern forms of benzodiazepines are more potent and pose a higher risk of overdose even when taken on their own, according to addiction doctors. Another danger comes from counterfeit forms of Xanax, which can contain the synthetic opioid fentanyl.

Benzo Addictions Develop

Benzodiazepines were originally introduced as a replacement for addictive barbiturates, but studies indicate that benzos are dangerously addictive as well. Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that benzodiazepine admissions almost tripled from 1998 to 2008, though overall treatment admissions increased just 11% during this period.

Benzodiazepine admissions during this time highlight how common it is for patients to combine benzo use with other drugs, as 95% of admissions related to benzodiazepines also reported use of another substance. Over 82% of patients reported primary use of another drug, with benzos secondary, while nearly 13% indicated that benzos were the primary substance being abused.

Patients cannot easily stop benzo use. Withdrawal symptoms typically start within 24 hours and may last for days or even months. American Addiction Centers reports that roughly 10% of people who abuse benzos continue to feel withdrawal symptoms years after they stop using the drugs. Withdrawal symptoms include the return of anxiety, insomnia, and panic attacks for those using the drug to treat these conditions. Nausea and vomiting, mood swings, twitching, seizures, blurred vision, hallucinations, and short-term memory problems can accompany withdrawal as well.

Local Authorities Take Preventive Measures

With the growth of awareness about benzodiazepines’ dangers, local and state governments began taking preventative measures. New York City, Hawaii, and Pennsylvania, for example, put a time limit on benzodiazepine prescriptions. Massachusetts released a bill on restricted medications that now included benzodiazepines.

According to the president of the American Society of Addiction Medicine and addiction doctor, Dr. Kelly Clark, “community mental health centers in Louisville stopped prescribing Xanax because it is such a common drug of abuse and so dangerous in combination with alcohol and opioids.”

Proposed Measures to Stall an Emerging Drug Epidemic

To ward off an upcoming drug epidemic and create higher safety standards, patient advocates and researchers are proposing various measures to increase awareness among medical students, doctors, and patients about benzodiazepines’ risk factors.

As she recovered from Xanax dependence, Dr. Christy Huff experienced the full extent of withdrawal symptoms that benzodiazepine patients go through. Now the co-director of a non-profit organization in Utah, the Benzodiazepine Information Coalition, Hugg spearheads the effort to include more effective warnings for patients and prescribing doctors.

Dr. Lembke, on the other hand, proposes the establishment of strict regulations that handle benzodiazepines like the opioid group of drugs: “We have this whole infrastructure set up now to prevent overprescribing of opioids and address the need for addiction treatment. We need to start making benzos part of that.”

The widespread use and growing availability of benzodiazepines have these drugs poised to become one of the next major drug epidemics in America. Public health professionals may be tasked with including benzo drug treatment and drug abuse prevention measures alongside similar actions being used for the opioid epidemic.

With advanced public health education and training, health officials will be better prepared to tackle the health challenges like addiction in the modern world. To learn more about pursuing a career in public health, visit the Keck School of Medicine of USC Master of Public Health program.

Sources:

FDA

Pew

thefix

CDC

Karger

CCHR

Montefiore

NIH

American Psychiatric Association

National Institute on Drug Abuse: Overdose Death Rates

CNBC

NCBI: Increasing Benzodiazepine Prescriptions

NCBI: Cohort Study on the Impact of High-Dose Opioid Analgesics on Overdose Mortality

CDC: Drug Overdose Deaths Among Women Aged 30-64 Years

Treatment Episode Data Set

NPR

National Institute on Drug Abuse: Research suggests benzodiazepine use is high while use disorder rates are low

American Addiction Centers