There is another drug crisis following the opioid crisis and that is the benzodiazepines with the brand names of Valium, Xanax, Klonopin and more. According to the journal Pharmacy, Xanax is among the top 25 drugs prescribed in this country.
As a psychiatric nurse practitioner working in community clinics in Chicago, I have been pleaded with, cursed at, insulted and spat upon by patients who insist on getting a prescription for drugs that I consider dangerous.
An article in The American Journal of Public Health warned that the amount of benzodiazepine prescribed has increased by over 300 percent in 17 years.
According to the National Institute on Drug Abuse, deaths from these drugs, especially when used with other respiratory depressants like alcohol and opioids, increased 8-fold from 2002-2016.
Twenty to 30 percent of people who use benzodiazepines for more than a few weeks to months and according to directions will become addicted. Detoxification from benzos is not pleasant; without medical supervision it can be life-threatening for some. A significant number of long-term users will find that they are permanently addicted.
Perhaps the nation can follow the example set by Massachusetts that in July 2018 passed a bill (H.3594) which mandates several forms of patient education prior to receiving benzodiazepines. Prescribers must also obtain written informed consent from the patient before writing the prescription. In addition, a commission was mandated to study the safe discontinuation of benzos, a vexing problem for providers and patients.
Some patients expect their health-care providers to be magicians who provide a quick fix for complex problems, such as anxiety and insomnia. Ideally the provider and patient are partners in a relationship working together to manage illness and improve quality of life.
For the patient, that could mean forgoing benzodiazepines in favor of safer medications and learning evidence-based self-help techniques like mindful meditation and yoga to manage stress.
World Benzodiazepine Awareness Day came and went this past July. In 2018 the Substance Abuse and Mental Health Services Administration announced a number of funding opportunities for programs targeting addiction and the opioid crisis, but did not mention benzodiazepines by name.
We have learned that one important driver of the American opioid crisis was the idea that pain is the “fifth vital sign” and must always be assessed and addressed. This idea was first promulgated in 1996 by the American Pain Society and quickly adopted by the Veterans Health Administration in its national pain management strategy.
Health-care providers worried about facing the pointed finger of “J’accuse” for negligence and downright cruelty toward their patients with pain if they avoided prescribing pain medications. Providers were shamed into aggressively treating many types of pain with powerful analgesics like opioids, thus fueling opioid addiction.
The benzo crisis is being fueled by the related idea that emotional distress is the 6th vital sign and must also be relieved by the health-care provider. To make matters worse, benzos are often co-prescribed with opioids, creating a more addictive and lethal cocktail.
To be sure, the benzodiazepines work very well to treat symptoms of anxiety and insomnia, but there can be terrible side effects, including the risk of memory loss, confusion, falls, dementia, addiction or respiratory arrest.
To protect their patients, health-care providers need to stop the liberal use of benzodiazepines. Policymakers can insist on educational guidelines. As well, patients must realize that there’s no free lunch when it comes to benzos.
Long term, they are no one’s little helpers. They are killing us.
Lois M. Platt is an assistant professor at Rush University College of Nursing and is a public voices fellow through The OpEd Project.