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Fatal overdose four times more likely when opioids and benzodiazepines are combined, says new research
The risk of fatal overdose when opioids are combined with other central nervous system (CNS) depressants such as benzodiazepines and barbiturates has been known for decades.
Yet throughout those decades, people have continued to combine those drugs, often finding themselves in emergency wards, or worse – pushing up daisies.
If you ever needed a really convincing reason to avoid combining opioid painkillers and benzodiazepines, that reason has now been found.
A research project published in the British Medical Journal (BMJ) clearly shows that the risk of a fatal opioid overdose is four times greater when opioids are combined with other CNS depressants such as benzodiazepines. Other CNS depressants are barbiturates and alcohol.
The high risk of overdose remains even if the opioids are at a relatively low dose. All it takes is a normal dose of benzodiazepines along with the opioids, the study found.
The researchers identified 2,400 cases of overdose fatalities among 422,786 veterans prescribed opioids for pain. About a quarter of those patients (112,069) were also prescribed benzos. But half of those 2,400 deaths occurred in the patients taking both opioids and benzos.
This research helps explain why such a large percentage of opioid-related fatalities are found to be “multidrug” fatalities in post-mortem drug studies. And it reveals why the vast majority of those multidrug combinations are benzodiazepines and opioids, or even alcohol and opioids, or opioids AND benzos AND alcohol.
Drug combining is always a bad idea
Back in the 1970s, ‘80s and ‘90s, a combination of drugs called a “speedball” was enormously popular, especially among a certain class of entertainers who lived “high off the hog” – and we mean “high.”
Remember River Phoenix, the late, albeit talented brother of Hollywood actor Joaquin Phoenix? How about famed Saturday Night Live stars John Belushi and Chris Farley?
All three – and countless others – succumbed to fatal overdoses of the nefarious speedball – the highly dangerous combination of opioids and cocaine – downers with uppers.
When you combine a CNS depressant (downers, like opioids) with a CNS stimulant (uppers, like cocaine) you are asking the body and brain to perform some kind of impossible miracle, i.e., lie down and chill out and jump up and run around all at the same time. We’re told the result is a unique sensation enjoyable for the few who survive it.
Of course it’s also powerfully addictive and enormously damaging to various organs. And it’s very often fatal.
Similarly, combining uppers with uppers can just blow your mind – well, actually, your heart and nervous system eventually just give up. It’s like racing the family sedan at top speed until it just melts down.
Doctors need to pay more attention to co-prescribing
With the advent in recent years of more and more prescription opioid painkillers, more and more benzodiazepines and of course, more and more cheap heroin, the inimitable speedball has become mostly a blast from the past.
The practice of co-prescribing painkillers and benzos is extremely widespread, according to numerous sources. The new research should throw new light on the extreme risks of doing so, and remind doctors to be much more careful how, and for whom, they are prescribing.
Dr. Tae Woo Park, the study author, said that when physicians prescribe benzodiazepines to people already on opioids, they should “understand that there may be an increased risk of overdose, and you should consider what disorder you are attempting to treat.”
By that he means that benzodiazepines are typically prescribed for anxiety disorders and insomnia, both of which are conditions that are “pretty common in patients with pain problems,” he said.
“You want to ensure that you are prescribing in an evidence-based manner, and carefully weigh the risks and benefits of treatment,” Dr. Park added.
Drug combining is always dicey
Whether you combine uppers with downers, uppers with uppers or downers with downers – and whether they are for a medical condition or recreational, drug combining is always more dangerous than just one drug at a time.
Of course, here at Novus, we’re deeply committed to helping people get off all drugs and get their lives back – drug free.
If you need help with a drug or alcohol problem, or know someone who does, don’t hesitate – call us now.
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