U.S. - FDA Boosts Warning On Danger Of Combining Opioids And Anxiety Meds

S.J.B.

S.J.B.

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FDA Boosts Warning On Danger Of Combining Opioids And Anxiety Meds
Joe Neel
NPR
August 31st, 2016

The Food and Drug Administration is warning that patients and doctors should more fully understand the potentially life-threatening risks of combining anti-anxiety or sleep medications with prescription opioids.

To that end, the agency is requiring that nearly 400 products carry a "black box warning" highlighting the risks from combined use, it said in a press release Wednesday. The risks include extreme sleepiness, respiratory depression, coma and death.

The move comes after an extensive review of scientific evidence by the FDA showing that physicians have been increasingly prescribing these drugs together. There was also a request for action in February, when health officials in cities and states across the country petitioned the agency for the change to the drug labels, citing an increase in overdoses from simultaneous use of the drugs.

"As an emergency physician, I have seen so many patients who are prescribed opioids and benzodiazepines together," wrote Dr. Leana Wen, Baltimore's health commissioner and a leader of the effort, on Twitter Wednesday. "A black box warning is a powerful education tool and thank [you to the FDA] for taking action to help prevent deaths from this dangerous combination."

From 2004 to 2011, the FDA says, the rate of emergency department visits involving nonmedical use of both drug classes increased significantly. Overdose deaths from taking prescribed or greater-than-prescribed doses of both drug classes nearly tripled, according to the release.
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Jesus christ. Sometimes my colleagues and I crack jokes about how the M.D.'s we work with don't know all that much about basic science - but we also know there's a lot more to being a physician than that, plenty of them are brilliant, etc.

It nonetheless boggles my mind that anyone would prescribe benzos and opioids to the same patient at the same time. You don't have to know very much about the human body to understand why that's stupid as hell.
 
While I think it should be an absolute last resort, sometimes people are driven by necessity, including doctors. It's risky, but that risk has to be weighed against the potential benefits for some people who will have a need for both classes of drugs (although of course the dosing should be very closely monitored). There's no rule in medicine which says that it's impossible for a person suffer from both severe pain (or opioid dependence requiring maintenance treatment) and severe anxiety or insomnia (or benzodiazapine dependence requiring maintenance treatment) simultaneously.

This is a good move though, people should absolutely be more informed, including doctors.
 
Benzos and opioids fulfill two different roles: the former class relieves anxiety, insomnia and some more, while the latter class is used against pain. Of course, some of the effects are present in both classes (anxiolysis, and sleepiness), but in general opioids are far inferior to benzos for insomnia, and I would also say that anxiety too. So it's not unthinkable that in some cases, a patient would need both classes of drugs to deal with different problems; for example, severe pain and insomnia.

Of course, that is not to say that everyone should be reckless in their dosing. But again, it's not impossible to use both classes simultaneously in a reasonable manner.
 
Clocktower said:
Jesus christ. Sometimes my colleagues and I crack jokes about how the M.D.'s we work with don't know all that much about basic science - but we also know there's a lot more to being a physician than that, plenty of them are brilliant, etc.

It nonetheless boggles my mind that anyone would prescribe benzos and opioids to the same patient at the same time. You don't have to know very much about the human body to understand why that's stupid as hell.
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I understand what you are saying BUT...it IS possible to use low doses of opiates safely while on low doses of Benzos.

I take 1.5mgs of Klonopin daily and needed Oxycodone and Hydrocodone during 3 extremely painful ACL surgeries/reconstructions/physical therapy periods in addition to a wrist ligament tear and not prescribing them to me would have caused me to go through more pain than I would have liked.

That was around the time I discovered this forum and read up on how to be as safe as possible when combining the two.

I will not deny that I DID also use larger amounts of Oxy and Hydro to get high while on Klonopin and that that certainly was not smart, but I still luckily ended up fine and did it on MANY occassions.

But THAT ASIDE...because it WAS stupid and should NOT be advised, if you are in medicine like you say you probably realize that there's no reason that LOW PRESCRIBED dosages of an opiate cannot be safely combined with LOW prescribed dosages of a benzo.

I mean whats that stuff they use to put you out during surgery called again that's a VERY powerful CNS depressant??

I also remember the doctors discussing the safety of putting me out with that while I was on Klonopin and for all 4 surgeries they concluded I'd be fine due to the low dose of benzo I was on and I was fine all times.

I do NOT believe it's a clear cut 100% FACT that doctors should NEVER EVER prescribe opiates to someone who is on benzos.

It's all a matter of the different factors, the dosages of each drug, the individuals medical history, age, weight, height and all sorts of other statistics that combine to form whether or not it is a safe decision and I'd imagine that MOST TRULY GOOD doctors can make the right call most of the time.
 
Shit everyone I know who gets pain meds also gets some type of benzo..one guy #120 roxi 30s #60 Xanax bars another #60 60mg ms contins #120 Percs 90 10mgvvaliun another #60 15mg morphine 120 percocets #60 2mg klonopin...shit, need I go on, it's basically everyone I know pretty much, not every one but ALOT. I mean it's fuckin fine as long as your not eating both like handfuls. A lot of ppl need both of these medications, but should of course be warned of dangers, but this is not something that should be used to scare doctors into not writing both...but it is going to neway.
 
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