Abuse may be obscuring other dangers
The war against the opioid epidemic in Massachusetts may be pushing another potential public health crisis into the shadows.
According to research by the U.S. Centers for Disease Control and Prevention, benzodiazepines – a class of anti-anxiety and insomnia drugs, such as Ativan, Klonopin and Xanax – were involved in 31 percent of all opioid-related overdose deaths in 2014.
Benzos, the shorthand name for the drug class, relieve anxiety by slowing the central nervous system. Opioids work on the brain and nervous system in the same way. The combination of the two can severely depress respiratory activity, with life threatening consequences. CDC data from 1999 through 2014 shows that overdose deaths due to benzos has increased 600 percent from 1,135 people in 1999 to 7,945 people in 2014.
An analysis of the CDC data by Dr. Marcus Bachhuber for the American Journal for Public Health, found that between 1996 and 2013, the number of adults filling a benzodiazepine prescriptions increased 67 percent, from 8.1 million to 13.5 million people. And, among people who filled benzo prescriptions, the amount more than doubled between 1996 and 2013, suggesting higher doses per patient. The study also showed that benzo-related deaths rose at a faster rate than both the number of people filling prescriptions or the quantity filled.
State Rep. Paul McMurtry, D-Dedham, has proposed a bill to limit and regulate benzodiazepine prescriptions. A hearing on the proposal held at the Statehouse in April, which included emotional testimony from addicts, survivors and healthcare providers. The bill was sent back to committee on study order and could remain there for months. Fall River Rep. Carole Fiola, who co-sponsored the bill, says the state should be doing more to regulate the drugs. “Massachusetts has always been a leader in many areas of legislation, and we are bringing up a conversation that is important to a lot of people,” Fiola said. “That’s our role and we will continue to gather the facts and research this over the next several months, and see what comes from that.”
Opponents say the threat from benzos is overblown.
Tufts Medical Center psychiatrist Dr. Edward Silberman, who testified against the bill, said benzos are a relatively safe drug. Unless a patient suffers from addiction to other substances as well, benzos can’t do much harm, he said. “These medications, taken alone, are amongst the safest medications that doctors prescribe,” Silberman said. “They’re safer than aspirin. It’s practically impossible to kill yourself by overdosing on benzodiazepines.”
However, Dr. Richard D. Lewis, who has worked in a New Bedford mental health clinic for 20 years, says doctors need to understand the deadly interaction between benzos and opiates. He maintains a blog for an addiction website called Mad in America, where recent post focuses on the deadly mix. “I think this crisis is going pretty much unnoticed,” Lewis said. “I would argue that you can’t solve or make a dent into the opiate crisis without addressing the benzo issue. Lewis says opioid addicts often are given Suboxone or Methadone, which are opiates, themselves. These individuals will, Lewis says, experience anxiety or trouble sleeping, often leading doctors to prescribe benzos. And that, Lewis says, can contribute to opioid overdoses because of the negative interactions of the two drugs. “Benzos and opiates will kill you,” Lewis said. “It’s the synergistic effect of one plus one becomes five.”
Statistics on benzo-related deaths in Massachusetts are hard to come by. Most of the focus by pathologists has been on calculating and tracking opioid deaths. According to Felix Browne, a spokesman for the state Office of Public Safety, statistics for overdose deaths can be misleading. He said cause of death is pulled from death certificates, which can be hastily done. Any conclusive determination in final autopsy reports require a full toxicology screening that can cost upwards of $2,500. The state Medical Examiner’s Office usually doesn’t do such screenings unless there are suspicious circumstances or the family requests it and pays the cost. Final autopsy reports can take from a few months to a few years, due to backlog in cases. Until completed, there’s no way of knowing how much of each drug was in the victim’s system at the time of death.
“The Medical Examiner’s Office has their own way of operating that is very little understood.” Browne said. “Survivors just want to know how their loved one died so they can move on. That’s what the death certificate is for. It’ll say something like ‘acute intoxication’ or ‘cardiac arrest,’ but it’s often more than one substance that’s involved. They don’t know until the full autopsy report is filed.”
Fiola says she hopes the bill will be reconsidered next session. But, Silberman says legislation isn’t the answer. “It’s really very difficult to legislate good medical practice. It’s a little bit like trying to legislate morality. You can have an impact, but it’s using a very broad brush to deal with a problem,” Silberman said. “In medicine, one should think about the individual patient, and one size doesn’t necessarily fit all.”