NEW STUDY INDICATES DEADLY OVERDOSES MAY RESULT FROM MIXING OPIOID ANALGESICS WITH BENZODIAZEPINE MEDICATIONS

NEW STUDY INDICATES DEADLY OVERDOSES MAY RESULT FROM MIXING OPIOID ANALGESICS WITH BENZODIAZEPINE MEDICATIONS

HealthDay (3/15, Reinberg) reports that mixing opioid pain analgesics with benzodiazepine medications may be “a prescription for a deadly overdose,” researchers concluded after examining data on some “300,000 privately insured patients.”

The study published on March 14, 2017, in the British Medical Journal (BMJ), sought to identify trends in the concurrent use of benzodiazepine and an opioid.  Data collected from 2001 to 2013 looked at the impact of mixing these drugs on admissions to hospitals and emergency rooms for opioid overdose.  The study concluded that “concurrent benzodiazepine/opioid use sharply increased in a large sample of privately insured patients in the US and significantly contributed to the overall population risk of opioid overdose.”

Benzodiazepines (benzos) are a class of psychoactive drugs that work on the central nervous system and are used to treat a range of conditions including anxiety and insomnia.  These drugs work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA).    They are responsible for reducing the activity of neurons that cause stress and anxiety.  These drugs are generally safe and efficient for short-term use.  However, benzos can be habit-forming, and the risks of long-term use are still being debated.

The more commonly prescribed benzos include Alprazolam (e.g., Xanax), lorazepam (e.g., Ativan), clonazepam (e.g., Klonopin), diazepam (e.g., Valium), and temazepam (e.g., Restoril) are the five most prescribed

Opioid addiction is at an epidemic level in the United States and in a December 2014 Express Script report it is estimated that 80 percent of the drugs are consumed by Americans.  Opioids work by blocking pain signals to the brain.   The more commonly known and prescribed painkillers include codeine, morphine, OxyContin® (oxycodone HCI), and Vicodin® (hydrocodone bitartate and acetaminophen).

“Nearly 60% of patients using opioids were taking a combination of drugs that are dangerous and potentially fatal; among these mixtures, almost one in three patients were prescribed anti-anxiety drugs known as benzodiazepines along with an opioid – the most common cause of overdose deaths involving multiple drugs,” the report (pdf), published by pharmacy benefit manager Express Scripts, said. [1]

The immediate risk of excessive use of benzos is the chance that they will be used in combination with alcohol or other drugs like opioids and cause an accidental overdose. Per the report, benzodiazepines have received less public safety attention than opioids, the combination of the two drugs is dangerous because benzodiazepines potentiate the respiratory depressant effects of opioids.[2]

Medical professionals need to make sure that patients fully understand the side effects of the drugs they are taking and the potential dangers of mixing these drugs with other drugs and alcohol.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription.

[1] “U.S.: 5% of World Population; 80% of Opioid Consumption.” Express Script Report December 2014. N.p., n.d. Web. 26 Mar. 2017 %3chttp:/www.allgov.com/news/controversies/us-5-percent-of-world-population-80-per%3e

[2] “Association between concurrent use of prescription opioids …” BMJ.com. N.p., n.d. Web. 26 Mar. 2017 %3chttp:/www.bmj.com/content/356/bmj.j760%3e

INSURERS DROPPING PRE-AUTH FOR ADDICTION TREATMENT

INSURERS DROPPING PRE-AUTH FOR ADDICTION TREATMENT

This month Aetna joined fellow insurers Anthem and Cigna in dropping the prior authorization requirement for privately insured patients to prescribe “particular medications ― such as Suboxone ― that are used to mitigate withdrawal symptoms.” Aetna is the third leading health care insurer to drop the pre-authorization in recent months.

Opioid abuse in the United States is a serious public health issue and drug overdose deaths involving opioids and heroin continue to sweep across the country at epidemic proportions. Suboxone is one of several drugs used to treat narcotic (opiate) addiction. To medical professionals, addiction specialists, and families of loved ones addicted to opioids and heroin, the pre-authorization that insurers currently have in place is a barrier to timely and effective treatment.

“This is great news,” says Dr. Henry Paul, Executive Director of the Karen Horney Clinic in NYC. “When a patient decides right then and there that they want treatment to kick their addiction, you need to begin treatment at that moment. The window of opportunity to treat patients who want to kick their addiction is minuscule and you can’t send them away expecting they’ll come back tomorrow. By then they will be back using because the craving for the drugs is just too powerful.”

In February NPR reported on Aetna’s change saying, “Specifically, the company will stop requiring doctors to seek approval from the insurance company before they prescribe particular medications ― such as Suboxone ― that are used to ease withdrawal symptoms.”

So how long were the pre-authorization delays? Sometimes hours and sometimes days. Pre-authorization may seem like a simple technicality but any delay, however brief, puts a person’s ability to get well at risk.

Both Cigna and Anthem changed their policy after facing an investigation by New York’s Attorney General in to whether their coverage practices unfairly barred patients from needed treatment. Aetna’s change takes effect this month and it is expected that more states will begin their own investigations and other insurers will follow suit and drop their pre-authorization requirement.

Another Big Health Insurer Loosens Rules For Covering Addiction Treatment  (NPR News, 2/15/2017)

Facing Pressure, Insurance Plans Loosen Rules For Covering Addiction Treatment  (KHN, 2/21/2017)

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription.