Opioid Addiction Risk Outweighs Danger of Methadone, Benzodiazepene Drug Interactions: FDA

Using benzodiazepines and opioid addiction drugs together is typically not recommended, because of serious potential side effects; but the FDA issued a new advisory last week, indicating that the benefits of treating painkiller addictions with those combinations outweighs the danger of using the medications together. 

The FDA advisory concerning addiction drugs and benzodiazepine use was issued September 20, recommending concurrent use when necessary.

In the past, the FDA warned against using opioid addiction medications, such as buprenorphine and methadone, with central nervous system (CNS) depressant drugs, like benzodiazepines and anti-anxiety medications, because they can slow down a person’s nervous system. However, the FDA now indicates that while some caution should be taken, the benefits of treating opioid addiction outweighs the risks of using the two types of drugs together. Thus, those drugs shouldn’t be withheld from patients if they are taking CNS depressants.

Buprenorphine and methadone help people reduce or end opioid addiction, which includes addiction to prescription narcotic painkillers and heroin. The drugs help reduce the side effects of opioid addiction by acting on the same parts of the brain that are affected by opioid addiction, reducing or eliminating withdrawal. These drugs are often invaluable in treating narcotic painkiller addiction.

Combined use of CNS depressant drugs and opioid addiction drugs carry some serious risks, including overdose and death. Yet, not treating opioid addictions may pose those same risks, yet at an increased rate.

The new recommendations come amid the worsening opioid abuse epidemic in the U.S. A recent study published in the Journal of the American Medical Association indicates that the rising death rates from opioid abuse are reducing the over all life-expectancy for Americans.

Opioid drug related deaths decreased American life expectancy by 3.5 months. This is the first decrease to life expectancy seen in the U.S. since 1993, the height of the AIDS epidemic.

The FDA recommends doctors take certain steps to reduce the risks of using the medications together. First, doctors should educate patients about the risks. Risks, like overdose and death, may still occur with CNS depressants even when the drugs are used as prescribed.

The agency also recommended doctors develop specific strategies to manage the use of CNS drugs, like benzodiazepines. They should taper CNS drugs, if possible, verify a specific diagnosis if the patient is receiving CNS drugs for anxiety or insomnia, and consider other treatment options for that diagnosis.

Doctors should also be aware patients may need addiction drugs, like buprenorphine, indefinitely, the FDA recommends. Patient’s should be advised to continue using the drug for as long as they benefit from taking the addiction medication.

The agency indicated that, if possible, doctors should coordinate care and prescribing with other doctors involved in their patient’s treatment and monitor the patient for illicit drug use, with blood or urine screening.

The FDA also indicated they will require the new recommendations be added to buprenorphine and methadone drug labels. They plan to also require detailed recommendations for reducing the use of addiction drugs and benzodiazepines together also be placed on drug labels.

Patients using either drug should never stop taking the medication without consulting their doctor first, the FDA warned. They should also speak to their doctor before starting new drugs and never take benzodiazepines, or other sedatives, that are not prescribed to them.