It’s not surprising that many military veterans have injuries and conditions that cause pain, and common opioids such as Vicodin, Percocet, and OxyContin are frequently prescribed to treat their discomfort. In addition, benzodiazepines (also called benzos) such as Xanax, Valium, and Klonopin are often used for treating vets who suffer from anxiety disorders, insomnia, and alcohol withdrawal symptoms.
Large numbers of veterans take both of these prescription medications regularly. In fact, almost 30 percent of 420,386 veterans surveyed were taking the two drugs — and a study shows that combination could be a life threatening.
A team of researchers from Rhode Island Hospital, Boston Medical Center, and the VA Ann Arbor Healthcare System found that veterans taking both opioids and benzos are at an increased risk of dying from a drug overdose.
An analysis of data on 2,400 vets who suffered fatal drug overdoses while receiving medical treatment from the Veterans Health Administration (VHA) as outpatients between 2004 and 2009 revealed that almost half of those who tragically OD’d on opioids during those years were also taking benzos.
“The risk of receiving both opioids and benzodiazepines during this six-year period was approximately four times higher than in those who received opioids alone,” said researcher Tae Woo Park, MD, of Rhode Island Hospital.
The researchers pointed out that benzodiazepines are prescribed more often to veterans who have substance abuse and other psychiatric disorders — and those problems alone raise the risk for death for intentional drug overdoses. The study also found doctors were more like to prescribe benzos for middle-aged vets. Women veterans were the most likely of all to be taking benzodiazepines.
The anti-anxiety drugs seem to be a key to the deadly outcomes, but the researchers were unable to determine exactly how or why. They pointed out, however, the risks of over-sedation from benzos are believed to be magnified when the drugs are combined with other sedating medications, such as opioids.
The research team noted veterans who overdosed on opioids were typically taking higher than average doses of benzodiazepines. They also discovered the risk of overdosing dropped for VHA patients who stopped taking benzos or only took the pain pills.
“From a public health perspective, this is deeply troubling, because drug overdoses are a leading cause of death in the U.S., and prescribing benzodiazepines to patients taking opioids for pain is quite common,” Park said. “In 2010, 75 percent of pharmaceutical-related drug overdose deaths involved opioids. As we learn more about pharmaceuticals and how they interact with each other, we can try to reduce the risk of harm to patients.”
The bottom line, according to the study, is that VA doctors need to exercise caution about prescribing benzodiazepines to veterans who are already taking opioid painkillers.
Another study earlier this year raised an additional red flag about prescription opioids frequently prescribed for veterans and others suffering from ongoing pain. A National Institutes of Health panel determined there’s no solid evidence that long-term opioid use (taken for a year or more) is an effective treatment for chronic pain.
However, these medications are often prescribed for vets and others on an on-going basis, despite the fact the drugs can be addictive and are linked to overdose deaths, the research panel pointed out. More than 16,000 people died from prescription opioid overdoses in 2012, according to the Centers for Disease Control and Prevention, resulting in more deaths than motor vehicle accidents for people between the ages 25 of 64.
October 01, 2015
Christopher Nystuen, MD, MBA