The death rate from overdoses involving benzodiazepines, a class of sedatives that includes Xanax, Valium, and Klonopin, has increased more than four-fold since 1996, according to a study appearing online in the American Journal of Public Health.
The drugs are prescribed for conditions such as anxiety, mood disorders and insomnia.
The study, led by researchers at Albert Einstein College of Medicine, Montefiore Health System and the Perelman School of Medicine at University of Pennsylvania also found:
• The number of adults filling a benzodiazepine (sedatives such as Valium or Xanax) prescription increased. According to the study, about 1 in 20 U.S. adults fills a benzodiazepine prescription during the course of a year.
• Among those receiving a prescription, the quantity of benzodiazepines filled increased on average.
• The rate of fatal overdoses increased faster than the amount prescribed, suggesting that people have been using them in a more risky way over time.
“Benzodiazepines are often on preferred drug lists because they are ‘cheap’ medications,” says lead author Marcus Bachhuber, MD, MS, assistant professor of medicine at Einstein and primary care physician at Montefiore. “But they are conclusively linked with adverse health effects such as falls, fractures, and motor vehicle accidents. In addition, they can cause overdoses by themselves and, in particular, when combined with other medications or illicit drugs.”
In 2013, benzodiazepines were involved in 31% of the nearly 23,000 deaths from prescription drug overdoses in the U.S. But not much was known about the national trends in benzodiazepine prescribing or in fatalities from the drugs.
To find out, Bachhuber and his colleagues performed trend analyses for both prescriptions and overdose death data for the years 1996 to 2013 from the Medical Expenditure Panel and multiple-cause-of-death data from the Centers for Disease Control and Prevention.
Their analysis showed that the number of adults purchasing a benzodiazepine prescription increased by 67% over the 18-year period, from 8.1 million prescriptions in 1996 to 13.5 million in 2013. For those obtaining benzodiazepine prescriptions, the average quantity filled during the year more than doubled between 1996 and 2013. The overdose death rate over the 18-year period increased from 0.58 deaths per 100,000 adults in 1996 to 3.14 deaths per 100,000 adults in 2013, a more than four-fold increase.
Overall, the rate of overdose deaths from benzodiazepines has leveled off since 2010. But for a few groups, adults aged 65 and older and for blacks and Hispanics, the rate of overdose deaths after 2010 continued to rise.
“Managed care executives should take into account the real cost of these medications, factoring in their consequences,” Bachhuber says. “They should consider changing coverage of benzodiazepines, or making alternative medications or talk therapies more available. Future research is needed to understand the reasons underlying the increases in prescriptions that we found.”