Beyond Opioids: America’s New Drug Epidemic

For 41-year-old cardiologist Christy Huff, life—once fulfilling and happy—is an unrecognizable nightmare. She’s incapacitated by a laundry list of symptoms (pounding heart, severe nausea, low appetite, insomnia, muscle spasm, acid reflux, severe constipation, confusion, anxiety, and depression) and needs a nanny to look after the basic day-to-day needs of her 6-year-old child. Her anxiety is excruciating. “I constantly live in a state of terror,” Dr. Huff says.

The only fortunate part is that she made the decision several years ago to put her medical practice on hold to be a stay-at-home mom. These days, she says, she’s barely existing. Working as a physician would be out of the question.

Dr. Huff’s terrifying misadventure began innocuously enough. She was prescribed alprazolam 0.5 mg three times daily by her primary care physician in August 2015 for severe dry eye syndrome. The benzodiazepine, her doctor told her, would help her sleep.

After only a few weeks, she began to experience severe anxiety, which required an increase in alprazolam. Then came the chest tightness, difficulty breathing, inability to swallow, and tremors. Research told her she was not only dependent on the drug after just a few weeks but was also experiencing symptoms of interdose withdrawal.

She found a psychiatrist who agreed to help her wean off the alprazolam by crossing over to diazepam. More than two years later, she’s still struggling. “My taper progress is slow and painful,” she says.

Believe it not, she’s one of the lucky ones.

In the last few years, the dangers of opioids have become a hot topic as the number of narcotic overdose deaths has skyrocketed. But now, a new drug crisis has America in its grip.

Studies show that the use of benzodiazepines—prescribed for insomnia, anxiety, and other behavioral health conditions—is on a sharp upward trend. Benzos are now among the most frequently prescribed medications in the country, and the number of related fatalities has soared, with almost 7,000 people dying annually from overdose or too-rapid withdrawal. Many more, like Dr. Huff, have suffered debilitating effects.

In short-term use, benzodiazepines can be valuable, sometimes even life-saving, across a wide range of clinical conditions. They’re fast and effective as anxiolytics, hypnotics, myorelaxants, anticonvulsants, and sedatives for medical procedures.

But the downside is significant. Patients can experience side effects even when taking benzodiazepines at the recommended dose. The risk of adverse effects increases significantly as the dose rises, or when benzodiazepines are taken with antidepressants or oral contraceptives. Benzos can cause suicidal thoughts and actions and present special risks for pregnant women and the elderly. They’re also addictive.

In 2016, the FDA issued a warning to healthcare professionals that opioids and benzodiazepines should not be prescribed together unless alternative treatments are inadequate, as the combination increases risks of oversedation and death. In fact, benzodiazepines have additive effects with several other drugs that have sedative actions, as well as with alcohol.

What makes this issue scary for me on a personal level is realizing that Dr. Huff’s story could have been mine, or the story of one of my family members. My mother had a years-long battle with chronic insomnia. After the usual “home remedies” (warm milk, hot baths, herbal tea, tryptophan-laden turkey) didn’t work, her doctor prescribed a benzodiazepine. I distinctly remember her cutting those tiny white pills into fragments; she would take one sliver only as needed, worried that she’d become addicted to them and would never be able to sleep naturally again.

My mother has passed away, but the problem lives on. Several of my siblings have sleep disorders. My oldest brother sometimes can’t sleep for days, but he won’t take anything for it. This has been going on for years. One of my adult children—happy and healthy most of the time—experiences episodes of significant anxiety, a condition made worse after several deaths in the family in fairly quick succession. A physician suggested alprazolam, but I urged him to try cognitive therapy first.

It’s not that I don’t believe in medication when appropriate, but as a CME researcher and writer, I read about medical (and medication) mishaps every day, and it’s made me even more gun-shy about pills than I was before. At my last checkup, the nurse expressed amazement that, “at my age,” I wasn’t on any medications at all. Most people, she said, are on three or four.

I think—and many researchers and healthcare providers agree—that we’re often a little too quick to throw pills at a problem that might be solved by other means. And by “we,” I mean patients requesting them and physicians prescribing them. One study noted that “Americans take more pills today than at any other time in recent history—and far more than people in any other country.” According to CDC and FDA statistics, nearly 1.3 million Americans ended up at the ED in 2014 because of adverse drug effects, and about 124,000 died.

When it comes to benzos, many patients and doctors don’t fully realize the risks or give much thought to safer alternatives. Last September, Dr. Huff testified before Massachusetts’ Committee on Mental Health and Substance Abuse in support of Bill H.3594, which would require a patient’s express informed consent and stricter regulation of benzodiazepines, possibly paving the way for similar legislation in other states. Dr. Huff testified that she—like countless fellow victims she has met since becoming ill—was prescribed this medication without being warned of the possible consequences by her doctor.

Despite receiving her medical training at two well-respected medical institutions, she said, she was “never educated about things like interdose withdrawal, tapering methods, severity of the withdrawal syndrome, and difficulty in discontinuation of the drug. I thought I was safe by taking a low dose of alprazolam for just a few weeks and [that] I could come off fairly easily. I was mistaken.” She added, “If this can happen to me, a physician who graduated at the top of her class, it can happen to anyone.”

Experts urge healthcare providers to read the latest research on benzodiazepines before prescribing them and to make sure that patients realize what they may be getting into—and what their other options are—before taking them.

They also suggest that providers give more consideration to natural, nonpharmaceutical treatments as alternatives. Growing evidence suggests that cognitive therapy, mindfulness, meditation, and yoga are effective for patients with depression, insomnia, and anxiety—and safer for doctors as well!

What have you and your organization done to manage benzodiazepine prescriptions and adverse consequences? Let me know in the comments below!

Sources:

An Act Relative to Benzodiazepines and Non-Benzodiazepine Hypnotics, HR 3594, 190th Leg (Ma). https://malegislature.gov/Bills/190/H3594.

Carr T. Too many meds? America’s love affair with prescription medication. Consumer Reports. August 3, 2017. www.consumerreports.org/prescription-drugs/too-many-meds-americas-love-affair-with-prescription-medication/#nation.

FDA Drug Safety Communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. August 31, 2016. www.fda.gov/Drugs/DrugSafety/ucm518473.htm.

Huff C. Dr. Christy Huff in support of Massachusetts Bill H.3594. September 7, 2017. www.benzoinfo.com/2017/09/07/dr-christy-huff-in-support-of-massachusetts-bill-h-3594.

National Institute of Mental Health. Despite risks, benzodiazepine use highest in older people. December 17, 2014. www.nimh.nih.gov/news/science-news/2014/despite-risks-benzodiazepine-use-highest-in-older-people.shtml.

Graphic below: Carr, 2017.