Xanax, Valium Overuse Problems Are Raising Concerns, NEJM Editorial Warns

The worsening opioid abuse epidemic in the United States may be overshadowing another serious prescription medication crisis, involving the overuse of benzodiazepines, such as Xanax and Valium.

In an editorial published last week in the New England Journal of Medicine, researchers warn that a widespread benzodiazepine crises is in full effect in the United States, with the medications increasingly abused alongside narcotic painkillers.

The Xanax and Valium overuse problems need to be addressed by health officials, according to the report, which suggests that the growing infrastructure established to deal with the opioid epidemic should be used to respond to dangerous trends in overuse, misuse and addiction to benzodiazepine drugs as well.

The editorial was written by Anna Lembke, M.D., Jennifer Papac, M.D., and Keith Humphreys, Ph.D., warning that benzodiazepine use has increased 67% between 1996 to 2003. In 1996, 8 million adults used benzos like Xanax, but by 2003 that number increased to 13.5 million.

At the same time, overdose deaths involving Valium and Xanax increased from 1,100 in 1999 to nearly 8,800 by 2015, indicated data from the National Institute on Drug Abuse. Overdose deaths involving benzodiazepines have increased at least fivefold since 1996. In the context of the opioid epidemic, benzodiazepines have been overlooked.

Researchers warned, “Overuse, misuse and addiction of benzodiazepines goes largely unnoticed.”

While the opioid crisis has gained more media attention in recent years, the crisis involving benzos has gained little, despite the fact that three-quarters of opioid deaths also involve drugs like Xanax and Valium.

Synthetic benzodiazepines have become increasingly popular. However, synthetic versions are just as deadly as the synthetic opioid fentanyl. Clonazolam, a synthetic analogue of clonazepam, is so strong it must be dosed in micrograms to prevent accidental overdose. It is also easily purchased on the internet as a “research chemical.”

Benzodiazepines, like Xanax, are a class of drugs that work on the brain’s neurotransmitters. They cause sedative and hypnotic effects and are often used to treat anxiety, insomnia, and seizures. However, benzos also increase the effects of opioid painkillers and depress respiratory function, leading to increased risk of opioid overdose.

In fact, rates of benzo and opioid co-prescribing increased from 9% in 2001 to 17% in 2013.

In 2016, the FDA issued a black box warning about co-prescribing benzos with opioids, indicating when taken together the risk of death greatly increases. Researchers indicated benzodiazepines, like alprazolam, clonazepam, and lorazepam are among the 10 most commonly prescribed psychotropic medications in the United States.

Study authors warn that drugs like Xanax and Valium should not be used for extended periods, or daily use. The benefits diminish with time and the risks increase.

“Many prescribers don’t realize benzodiazepines can be addictive when taken daily and can worsen anxiety, contribute to insomnia, and cause death,” wrote study authors. The exact ailments Xanax is prescribed to treat, may be caused by daily use of the drug.

Other risks of taking Xanax daily include cognitive decline, accidental injuries and falls, increased rates of hospital admission and emergency department visits. Researchers indicate there are other safer treatment alternatives for anxiety and insomnia, like antidepressants and behavioral interventions.

Study authors are calling for the national efforts to reduce overprescribing of opioids to be expanded to include drugs like Xanax and Valium. More so, doctors should check drug monitoring programs before prescribing benzos and offer a urine screening to make sure benzos aren’t taken with other drugs.

Opioid education should also include information concerning benzodiazepine prescribing and efforts should be made to shut down illegal online pharmacies.

“It would be a tragedy if measures to target overprescribing and overuse of opioids diverted people from one class of life-threatening drugs to another,” wrote study authors. “We believe that the growing infrastructure to address the opioid epidemic should be harnessed to respond to dangerous trends in benzodiazepine overuse, misuse, and addiction as well.”