The Washington PostDemocracy Dies in Darkness

The prescription drug epidemic no one’s talking about

Keith Humphreys for the Washington Post (Illustration by Keith Humphreys for the Washington Post)

Exploding prescription rates, widespread addiction and soaring overdose deaths are staples of media coverage of opioids. Yet these same phrases apply equally well to another class of prescription drugs whose impact has received little attention: benzodiazepines.

Most Americans will have heard the trade names of various benzodiazepines, such as Valium, Librium, Rohypnol, and Xanax (or their close pharmacological cousins Ambien and Lunesta). Physicians have long-prescribed them mainly for anxiety and insomnia. Like opioids, their effects on most users include relaxation and slowed breathing. Also like opioids, they are addictive and can cause an overdose.

Overdose deaths involving benzodiazepines increased more than 8-fold from 2000 (1,298 deaths) to 2016 (10,684 deaths). A massive increase in prescribing facilitated this horrifying rise in mortality. Between 1996 and 2013, the quantity of benzodiazepines doctors provided to Americans more than tripled.

Benzodiazepines can be fatal by themselves but typically cause overdose in combination with opioids because the sedative effects of the two drugs exacerbate each other. This is particularly concerning because the number of patients being prescribed both classes of medication simultaneously has increased sharply since 2000.

The risks of benzodiazepines have attracted far less attention than those of opioids. But a few government agencies have awakened to the problem. At the federal level, the Food and Drug Administration recently ordered that labels on benzodiazepines and opioids mention the risk of combined use, and the Veterans Health Administration is educating its prescribers about safer alternatives to benzodiazepines. At the state level, benzodiazepines are increasingly being included in prescription drug monitoring programs.

But many health-care organization, physicians and patients remain unaware of the country’s benzodiazepine problem. That must change if we are to reverse the rising tide of drug overdose deaths.