Prescription drug overdoses have become alarmingly common in the U.S., with opioid painkillers, such as Vicodin and Oxycontin, among the drugs most frequently making headlines.
New research shows another class of drugs — benzodiazepines or “benzos” — is rising in the ranks of overdose deaths, however.
Prescriptions for such drugs, which include brand names Valium, Ativan and Xanax, tripled from 1996 to 2013, but this doesn’t fully account for the uptick in overdoses, which quadrupled during that time period.
Anxiety Drug Overdoses Hit Record Levels
Researchers from the Albert Einstein College of Medicine in New York used data from the Medical Expenditure Panel Survey and multiple-cause-of-death data from the U.S. Centers for Disease Control and Prevention (CDC) to describe trends in benzodiazepine prescriptions and overdose deaths.
For starters, they found that the number of U.S. prescriptions for the drugs rose from 4.1 percent in 1996 to 5.6 percent in 2013 — a 37 percent increase.
Further, the rate of overdose deaths increased from 0.58 per 100,000 adults at the start of the study to about 3 per 100,000 adults at the end, which represented a more than 500 percent increase.
As for why the rate of overdose deaths rose faster than the rate of prescriptions, Dr. Chinazo Cunningham, one of the study’s authors, told STAT News, “Our guess is that people are using these prescriptions in a riskier way.”
The number of pills prescribed to each adult increased over the study period, for instance, which suggests Americans may be taking higher doses or taking the drugs for longer periods, both of which increase the risk of overdose.
Combining the drugs, which act as sedatives and are often prescribed not only for anxiety but also for insomnia, with alcohol is also risky, as is using the drugs along with opioids.
Dr. David Juurlink, head of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Center in Toronto, told STAT News, “Prescribing opioids and benzodiazepines together is like putting gasoline on a fire,” and added:
“Benzodiazepines are grossly overprescribed … and many people don’t necessarily benefit from them.”
(Dean/Flickr/CC BY)Opioids Combined With ‘Benzos’ Make Up More Than 30 Percent of Narcotic Deaths
CDC data also highlighted the growing risks of anxiety drugs. Benzodiazepines accounted for 31 percent of the narcotic overdose deaths in 2011 (up from 13 percent in 1999), according to a 2014 CDC Report.
Separate research showed the use of “benzos” has risen alongside the use of opioids, and the sedatives are often used alongside the painkillers to enhance the “high.”
If you’re wondering just how deadly opioids and benzos can be, in 2014 the state of Ohio used an opioid/benzo mix in a death-row execution after it couldn’t obtain the conventionally used drugs.
Despite their known risks, preliminary research presented at the 2014 meeting of the American Academy of Pain Medicine in Phoenix, Arizona found that 12.6 percent of all primary care visits made by Americans between 2002 and 2009 involved prescriptions for sedatives/anxiety drugs and/or narcotic painkillers (opioids).
The study also found:
- The number of prescriptions for anxiety drugs rose by 12.5 percent a year
- Patients receiving a narcotic painkiller were 4.2 times more likely to receive a second prescription for an anxiety drug
- The number of joint prescriptions of opioids and anxiety drugs also increased by 12 percent a year in that time frame
- Prescription anxiety drugs and narcotic painkillers are responsible for at least 30 percent of narcotic painkiller-related deaths
- Besides deaths caused by overdose, other risks associated with anxiety drug use include falls in the elderly, emergency room visits, and drug dependence
Even Children Are Overdosing on Anxiety Drugs
(perkmeup/iStock)
About 9,500 children younger than 6 are hospitalized each year after ingesting family members’ medications.
Among them, three-quarters are between the ages of 1 and 2. Likely echoing the sharp rise in adults’ use of opioids and benzodiazepines, both opioid painkillers and benzos topped the list of medications most often responsible for young children’s hospitalizations. According to the study:
“Emergency department visits and subsequent hospitalizations of young children after unsupervised ingestions of prescription medications are increasing despite widespread use of child-resistant packaging and caregiver education efforts …
Opioids (17.6%) and benzodiazepines (10.1%) were the most commonly implicated medication classes.”
Anxiety Drugs Are Highly Addictive
Benzodiazepines exert a calming effect by boosting the action of a neurotransmitter called gamma-aminobutyric acid (GABA) in the same way that opioids (heroin) and cannabinoids (cannabis) do. This in turn activates the gratification hormone, dopamine, in your brain.
Since the identical brain “reward pathways” are used by both types of drugs, they can be equally addictive and also may cause side effects like memory loss, hip fractures, impaired thinking, and dizziness.
Ironically, the symptoms of withdrawal from many of these anxiety medications include extreme states of anxiety — some of which are far worse than the original symptoms that justified treatment in the first place. Symptoms that may occur with benzodiazepine withdrawal include:
Why Benzodiazepines May Be Especially Dangerous for the Elderly
Up to 43 percent of older adults use benzodiazepines (Valium, Xanax, Ativan, etc.) for anxiety and insomnia, often chronically, even though their long-term effectiveness and safety remains unproven.
International guidelines recommend short-term use of benzodiazepines, because they cause withdrawal symptoms that make discontinuation problematic. Despite this, many seniors take them for years instead of a few weeks, as is recommended.
(Spencer Platt/Getty Images)
Further, older adults have a much more difficult time eliminating benzodiazepines and similar drugs from their bloodstreams, especially while on multiple medications, which overburden their detoxification systems. Over time, these drugs can accumulate in your body, which will increase your risk of an accidental overdose. As reported in Current Opinions in Psychiatry:
“Despite repeated recommendations to limit benzodiazepines to short-term use (2–4 weeks), doctors worldwide are still prescribing them for months or years. This over prescribing has resulted in large populations of long-term users who have become dependent on benzodiazepines and has also led to leakage of benzodiazepines into the illicit drug market …
Recent literature shows that benzodiazepines have all the characteristics of drugs of dependence and that they are inappropriately prescribed for many patients …”
Benzodiazepines May Increase Your Risk of Dementia
Aside from the risk of overdose and addiction, there’s another reason to carefully consider the use of anxiety drugs, especially for long-term use. Older adults who used benzodiazepines for three months or more had a 51 percent greater risk of Alzheimer’s disease than those who did not.
The risks increased the longer the drugs were used as well as with long-acting formulations. Additional studies also support this link:
- A 2012 study found that among adults over 65, those who used benzodiazepines were 50 percent more likely to develop dementia over a 15-year period. This was true even when taking into account other factors that might increase dementia risk, such as age and diabetes.
- A 2009 study found long-term use of benzodiazepines was significantly associated with an increased risk of dementia, leading researchers to recommend “long-term use of BZDs should be avoided among the elderly, who may be at a higher risk for developing dementia, in addition to other health problems.”
- A 2005 literature review found three of six papers reviewed found an increased risk of cognitive decline in benzodiazepine users.
- A 2002 study found former use of benzodiazepines was associated with a significantly increased risk of dementia.
Non-Drug Options for Relieving Anxiety
Both anxiety and sleep troubles are serious issues that need attention. Unfortunately, most people who suffer from these conditions either do nothing or resort to pharmaceutical drugs — many of which are ineffective and capable of destroying your health and sanity further.
In fact, it’s estimated that only one-third of people with anxiety disorders receive treatment, but keep in mind that “treatment” does not have to equal “drugs.” You have nothing to lose, and everything to gain, by applying lifestyle modifications before trying medication. You may be surprised by how much such changes lessen anxiety and improve your ability to sleep soundly, naturally.
Because anxiety drugs are often prescribed for sleep troubles, I suggest first reading my “Guide to a Good Night’s Sleep for 33 simple tips” on improving your sleep. Small adjustments to your daily routine and sleeping area can go a long way to ensure uninterrupted, restful sleep (which may further help with anxiety symptoms, as well). Beyond that, if you often feel anxious or have panic attacks I strongly recommend the following:
- Exercise
In addition to the creation of new neurons, including those that release the calming neurotransmitter GABA, exercise boosts levels of potent brain chemicals like serotonin, dopamine, and norepinephrine, which may help buffer some of the effects of stress. Many avid exercisers also feel a sense of euphoria after a workout, sometimes known as the “runner’s high.”
It can be quite addictive, in a good way, once you experience just how good it feels to get your heart rate up and your body moving.
- Optimizing Your Gut Flora
Your gut and brain actually work in tandem, each influencing the other. This is why your intestinal health can have such a profound influence on your mental health and vice versa. It’s also the reason why your diet is so closely linked to your mental health.
Prior research has shown that the probiotic Lactobacillus rhamnosus had a marked effect on GABA levels in certain brain regions and lowered the stress-induced hormone corticosterone, resulting in reduced anxiety- and depression-related behavior. The probiotic known as Bifidobacterium longum NCC3001 has also been shown to normalize anxiety-like behavior in mice with infectious colitis.
So optimizing your gut flora with beneficial bacteria is a highly useful strategy. This is done by eliminating sugars and processed foods and eating plenty of non-starchy vegetables, avoiding processed vegetable oils, and using healthy fats. Additionally, eating plenty of fermented vegetables or taking a high-potency probiotic would be useful to reestablish a healthy gut flora.
- Omega-3 Fats
Your diet should include a high-quality source of animal-based omega-3 fats. The omega-3 fats EPA and DHA play an important role in your emotional well-being, and research has shown a dramatic 20 percent reduction in anxiety among med students taking omega-3s.
