Emerging Trends and Risks in Drug Mixing: What You Need to Know

Risks of Mixing Drugs: A Focus on Benzodiazepines and Opioids

Understanding the Dangers

Mixing medications such as sleeping pills and opioid pain relievers poses significant health risks. A recent study delved into the prevalence, trends, and risk factors associated with this dangerous practice in the United States. Older adults and those with chronic illnesses are particularly vulnerable to inappropriate drug combinations.

Potential Consequences of Mixing Drugs

One major concern of mixing medications is the potential for adverse drug interactions and side effects. Benzodiazepines and opioids are commonly taken together, and while no direct drug interactions exist between them, their side effects overlap considerably. Both classes of drugs can depress the central nervous system, leading to slowed or difficult breathing and increased sedation. The concurrent use of these medications can amplify these effects, resulting in serious and potentially fatal outcomes.

Increased Mortality and Morbidity Risks

Due to the heightened risks, the U.S. Food and Drug Administration (FDA) has issued warnings regarding the combined use of benzodiazepines and opioids. This caution is reflected in labeling on all related medications. Research indicates that mixing these drugs significantly increases the likelihood of emergency room visits and hospital admissions, with the risk more than doubling.

The Risks of Mixing Different Benzodiazepines

Types of Benzodiazepines

Another concerning practice involves the simultaneous use of multiple benzodiazepines. There are two categories of these medications: nonselective and selective benzodiazepine receptor modulators. Selective modulators target specific GABA receptors in the brain, which are linked to sedative effects, while nonselective modulators affect a broader range of GABA receptors.

Misconceptions Among Healthcare Providers

The naming conventions of these drugs often lead to confusion. Nonselective benzodiazepines typically end with “lam” or “pam,” such as alprazolam and lorazepam, whereas selective benzodiazepines usually begin with “z,” including zopiclone and zolpidem. This can mislead healthcare providers into underestimating the risks associated with selective benzodiazepines.

Research Findings from St. Michael’s Hospital

Researchers from St. Michael’s Hospital in Toronto conducted an analysis on the prevalence, trends, and risk factors of mixing benzodiazepines, both selective and nonselective, along with opioids in the U.S. population. Their findings were published in the journal Sleep. The study used data from the National Health and Nutrition Examination Surveys (NHANES), covering 16 years from 1999 to 2014, representing the civilian U.S. population.

Trends in Drug Mixing

Rising Prevalence of Drug Mixing

The study revealed a concerning increase in the concurrent use of benzodiazepines and opioids, with prevalence rising from 0.39% in 1999-2000 to 1.36% in 2013-2014. Additionally, the mixing of nonselective and selective benzodiazepines grew from 0.05% to 0.47% during the same period. While these percentages may seem low, they equate to millions of individuals in the U.S.

Demographic Insights

Data collected in the study provided insights into the trends and risk factors for drug mixing. Although women are more frequently prescribed benzodiazepines and opioids, gender did not show a significant correlation with the risk of mixing these drugs.

Impact of Age and Ethnicity

Older adults generally have higher rates of benzodiazepine and opioid use; however, this analysis found that older age was not strongly linked to drug mixing. While Caucasians were more likely to use different benzodiazepines compared to other ethnic groups, behaviors such as smoking and alcohol abuse did not correlate with increased mixing risk.

Associations with Health Conditions

The study also highlighted that psychiatric disorders were linked to drug mixing, as conditions such as pain, insomnia, and anxiety are often comorbid. Additionally, chronic pain conditions like arthritis were associated with increased benzodiazepine usage. Notably, morbid obesity was found to correlate with the use of multiple benzodiazepines, as decreased physical activity can lead to weight gain and related health issues.

Strengths and Limitations of the Study

Study Strengths

The extensive data collected over nearly two decades, including prescription use and health metrics, strengthens the study’s findings. Objective confirmation of patient drug use through NHANES minimizes reliance on self-reported data.

Study Limitations

However, a limitation of the research is that it only assessed drug use within the 30 days preceding the survey, leaving other periods unexamined. Additionally, the study did not evaluate the specifics of psychoactive drug use, which could affect the accuracy of the findings.

Conclusion and Future Research Directions

The findings of this study confirm a troubling trend in the mixing of benzodiazepines and opioids over the past two decades. Further research is essential to understand the underlying causes of this increase in inappropriate drug combinations. Certain patient populations are particularly at risk, and effective strategies are necessary to mitigate the dangers associated with these practices.

Written by Jessica Caporuscio, PharmD

References:
Vozoris NT. Benzodiazepine and Opioid Co-Usage in the United States Population, 1999-2014: An Exploratory Analysis. Sleep. 2019.
Wolters Kluwer Clinical Drug Information, Inc. (Lexi-Drugs). Wolters Kluwer Clinical Drug Information, Inc.; January 30, 2019.