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Antianxiety Drugs Tied To Increase In Overdose Deaths

Antianxiety Drugs Tied To Increase In Overdose Deaths

The number of prescriptions for antianxiety drugs, such as benzodiazepines (Valium, Xanax, Ativan, Clonazepam, Klonopin, etc.), is on the rise. Research by the National Institute of Drug Abuse found there has been a 67 percent increase in prescriptions from 1996 to 2013.[1]

This increase has also caused an increase in the number of overdose deaths involving these types of medications. These deaths are caused by overdosing on the antianxiety drugs themselves, and more so when used with alcohol or opioids.

A study by the Centers for Disease Control and Prevention (CDC) found the number of benzo involved overdoses increased from 0.54 per 100,000 in 1999 to 5.02 per 100,000 in 2017 among women aged 30 to 64.[2] That’s a sharp rise of 830 percent only surpassed by increases in synthetic opioid or heroin deaths.

Benzo Overdose Deaths

Overall, there were 10,684 benzo-related overdose deaths in the United States in 2016.

Benzodiazepines (“benzos”) create their effect by binding to GABA receptors in the brain. GABA (gamma-aminobutyric acid) is the brain’s most powerful inhibitory neurotransmitter. Enhancing GABA binding creates a sedative effect.

“The brain basically compensates … by downregulating its own internal mechanisms for calming the brain,” said Dr. Anna Lembke, chief of the Stanford Addiction Medicine Dual Diagnosis Clinic.[3]

While using a benzo as prescribed once and a while can help the body calm down, overdosing on benzos can slow breathing to the point of death. Combining benzos with other nervous system suppressants, such as alcohol and opioids, can compound this effect, which can “cause people to fall asleep and essentially never wake up again,” says Anna Lembke.

Benzos, when used intermittently (a few times over a few weeks) are generally considered safe. But chemical addiction can occur when used regularly (once per day) in as little as three weeks. When addicted, benzos become less effective and the person “needs more and more to get the same effect,” Lembke says. “It’s really easy to get people on these drugs, and hard to get them off again.”

Furthermore, many people who take these drugs aren’t using them properly. One study found that nearly 20 percent of people who use benzos misuse them, such as taking them without a prescription or in a way not approved of by a doctor.[4]

Lembke and colleagues suggest national efforts to combat the opioid crisis should also include benzos to reduce their over-prescription and to educate doctors about their risks.

Since there are many natural and safer treatments for anxiety and sleep disorders, such as cognitive therapy (which is the Gold Standard treatment for anxiety and insomnia),[5][6][7][8][9] deep relaxation, mindfulness meditation, and stress reduction, doctors need to be rethinking their approach for these disorders.

REFERENCES:

1. "Benzodiazepines and Opioids." National Institute of Drug Abuse, March 2018, https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids#graph

2. “Morbidity and Mortality Weekly Report (MMWR).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Jan. 2019, www.cdc.gov/mmwr/volumes/68/wr/mm6801a1.htm?s_cid=mm6801a1_w.

3. Lembke, Anna, et. al. "Our Other Prescription Drug Problem." The New England Journal of Medicine, 22, Feb. 2018, https://www.nejm.org/doi/full/10.1056/NEJMp1715050?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed

4. Maust, DT., et al. "Benzodiazepine Use and Misuse Among Adults in the United States." Psychiatric Services. Published online December 17, 2018.  doi:10.1176/appi.ps.201800321.

5. David, Daniel, et al. “Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy.” US National Library of Medicine, 29, Jan. 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797481/

6. Hofmann, Stefan, et al. “The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses.” US National Library of Medicine, 1 Oct. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/

7. Leahy, Robert L. “Cognitive-Behavioral Therapy: Proven Effectiveness.” Psychology Today, Sussex Publishers, Nov. 2011, www.psychologytoday.com/us/blog/anxiety-files/201111/cognitive-behavioral-therapy-proven-effectiveness.

8. Brasure, M., Fuchs, E., MacDonald, R., Nelson, V.A., Koffel, E., Olson, C.M., . . . Kane, R.L. (2016). Psychological and behavioral interventions for managing insomnia disorder: An evidence report for a clinical practice guideline by the American College of Physicians. Annals of Internal Medicine. Retrieved from http://annals.org/article.aspx?articleid=2519966

9. Lee, Christopher William, et al. “Effective Insomnia Treatments: Investigation of Processes in Mindfulness and Cognitive Therapy | Behaviour Change.” Cambridge Core, Cambridge University Press, 8 June 2018, www.cambridge.org/core/journals/behaviour-change/article/effective-insomnia-treatments-investigation-of-processes-in-mindfulness-and-cognitive-therapy/0AF5C54E2DDAED377EF31581701806FE.

 


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Authors: Jim Folk, Marilyn Folk, BScN. Last updated January 21, 2019.

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