Two drugs prescribed to millions of Americans could have deadly effects when taken together, doctors warn.
People prescribed both opioid painkillers and benzodiazepines such as Xanax have a 71 percent increased risk of dying from any cause.
Both classes of the drugs slow a person’s breathing and taking them at the same time, a combination that led to the deaths of actors Heath Ledger and Philip Seymour Hoffman, raises the risk of lowering respiration so severely that a person completely stops breathing.
The new report – which looked at veterans affairs records – found patients were also 42 percent more likely to die by suicide. However, researchers said data on this link is not conclusive due to the small sample size and more research into the relationship is needed.
Despite the heightened risks, researchers found, despite the known risks of taking both classes of drugs, 27 percent of veterans taking opioids were also given benzodiazepines.
According to the CDC, about 125million opioid prescriptions were dispensed to Americans in 2023 and the FDA reports approximately 92million benzodiazepine prescriptions were dispensed in the US in 2019 – the latest data the agency has available.
And in 2021, nearly 14 percent of all overdose deaths involving opioids also involved benzodiazepines, according to the National Institutes of Health (NIH).
Common prescription opioids include oxycodone, Vicodin, codeine and fentanyl. Some benzodiazepines include Valium, Xanax, Ativan and Klonopin.
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According to the new report, compiled by the Committee on Evaluating the Effects of Opioids and Benzodiazepines on All-Cause Mortality in Veterans, from 2007 to 2019, 637,800 veterans were regularly dispensed opioids.
During these years, there were 16,900 deaths from all causes and 300 from suicides.
Among the all-cause deaths, 4,800 involved both an opioid and a benzodiazepine, about 28 percent
Among the deaths by suicide, 64 involved a patient taking both an opioid and a benzodiazepine, about 21 percent.
However, the number of suicides included in the data was relatively small, so, Brian Strom, chair of the committee that wrote the report, said the data may be ‘imprecise.’
Additionally, the report found veterans were more at risk of dying if they had higher opioid dosages or had their doses increased or decreased too quickly, though the researchers said there was not enough data to explain why.
There has long been a concern over the co-prescription of opioids and benzodiazepines.
Side effects of both classes of drugs include a decreased breathing rate, erratic and irregular breathing and diminished oxygen levels in the body.
When combined, the side effects from each are compounded, meaning a person’s breathing can be slowed down so much they stop breathing altogether.
The NIH stated: ‘Combining opioids and benzodiazepines can increase risk of overdose because both types of drugs can cause sedation and suppress breathing — the cause of overdose fatality — in addition to impairing cognitive functions.’
The FDA added: ‘A review has found that the growing combined use of opioid medicines with benzodiazepines or other drugs that depress the central nervous system (CNS) has resulted in serious side effects, including slowed or difficult breathing and deaths.
In response, the FDA issued Boxed Warnings, its strongest warning, to the labeling of prescription opioids and benzodiazepines.
Veterans have a 72 percent higher risk of suicide than those who haven’t served
The agency urged doctors to limit the co-prescribing of these two drugs and warn patients and care givers ‘about the risks of slowed or difficult breathing and/or sedation.’
Opioids are typically given for pain relief, while benzodiazepines are prescribed for conditions like PTSD, anxiety, seizures and insomnia.
Common prescription opioids include oxycodone, brand name OxyContin and Percocet, hydrocodone, brand name Vicodin, hydromorphone, brand name Dilaudid, codeine, morphine and fentanyl.
Some benzodiazepines include Valium, Xanax, Halcion, Ativan and Klonopin.
In 2004, 19 percent of veterans received opioid prescriptions and in 2013 that increased to 33 percent.
However, VA systems implemented a new pain management protocol that ‘focuses on the veteran as a whole person,’ looking at factors like nutrition, physical exercise and sleep instead of ‘relying on one treatment’ — pharmaceuticals.
Since then, the VA has reported opioid prescriptions have declined and in 2023, 289,000 veterans were prescribed opioids – a 67 percent reduction from the 875,000 a decade earlier.
