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Combining benzodiazepines with other substances raises risks

Benzodiazepines, such as alprazolam, diazepam, clonazepam and lorazepam, are a class of drugs used to relieve symptoms of anxiety, panic attacks and seizures. They are usually safe when taken as prescribed and directed under a health professional’s supervision. However, benzodiazepines can sometimes cause adverse effects – especially if used improperly or in combination with substances like opioid pain relievers or alcohol.

A new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that 32 percent of hospital emergency department visits involving benzodiazepines resulted in serious medical outcomes such as hospitalization (or in rare cases death).

In emergency department visits involving the use of benzodiazepines in combination with opioid pain relievers the risk of a serious outcome rose to 44 percent. Similarly, 44 percent of emergency department visits associated with the combined use of benzodiazepines and alcohol resulted in serious medical outcomes. Serious health results occurred in 50 percent of hospital emergency visits involving the combined use of benzodiazepines, opioid pain relievers and alcohol. This report only analyzed emergency department visits invovlving benzodiazepines alcohol and opioids.

SAMHSA’s report also indicates that older patients may be at significantly higher risk for serious health outcomes. Seventy percent of emergency department visits involving people aged 65 or older who had combined benzodiazepines with alcohol and opioid pain relievers resulted in serious outcomes, compared to 39 percent of visits involving people aged 12 to 34 using the same combination of substances.

"Benzodiazepines are commonly prescribed medications that can benefit some patients but, like all medications they must be properly used and monitored," said SAMHSA’s Chief Medical Officer, Dr. Elinore McCance-Katz. “The adverse events being seen in emergency departments are often the result of drug-drug interactions that can occur between benzodiazepines, opioids and alcohol. Physicians and other prescribers must inform patients taking these medicines of the potential risk of drug interactions that can result in serious adverse events and even death. Healthcare providers and patients must work together to ensure that prescribed medications are taken in a way that maximizes benefits and diminishes risks."

SAMHSA’s Center for Substance Abuse Prevention has several initiatives to prevent the misuse of prescription drugs. These include school-based programs educating parents and students about the potential dangers of misusing prescription drugs. Other prevention programs provide informational materials to health professionals, including prescribers, on the risk of overprescribing.

SAMHSA grant programs like the Substance Abuse Prevention and Treatment Block Grant, and Partnerships for Success, fund a wide variety of programs designed to help prevent prescription drug misuse and abuse, such as ensuring proper training of first responders for drug overdose situations and implementing prescription drug take-back programs for unused medications.

The report entitled, Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious Emergency Department Visit Outcomes is based on findings from the 2005 to 2011 Drug Abuse Warning Network (DAWN) reports. DAWN is a public health surveillance system that monitored drug-related morbidity and mortality through reports from a network of hospitals across the nation. In 2011 DAWN reported that there were approximately 5 million substance-related visits to hospital emergency departments.

The complete survey findings are available on the SAMHSA web site at: http://www.samhsa.gov/data/sites/default/files/DAWN-SR192-BenzoCombos-2014/DAWN-SR192-BenzoCombos-2014.pdf.

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