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With Some Drug Combinations, Overdose Might Be In The Prescription


The dangerous practice of mixing benzodiazepines and opiates doesn't just lie with people like Sayra Small, who was abusing heroin. New research suggests that part of the problem may lie with primary care doctors who are prescribing a mix of benzos for anxiety and opioids for pain.

Those are the findings of Dr. Sean Mackey. He joins us now. He is the chief of pain medicine at Stanford School of Medicine. Welcome to the program.

SEAN MACKEY: Great to be here, thank you.

CORNISH: So to begin, Sean Mackey, what are we talking about when we say these drugs are being prescribed in combination? Describe a scenario where a patient comes to a doctor and he suggests this combination.

MACKEY: Certainly. So, you know, imagine a 35, 40-year-old guy comes in who has an anxiety disorder. They're already on the benzodiazepine but they had an acute injury, and so the primary care doctor may put them on an opioid. And that's what we're seeing now, all kinds of scenarios where somebody is being put on both of these agents together. And it's that combination that may be leading to many of the problems we're seeing.

CORNISH: So help put the concept of the overdose and the problem with the combination in context. Are people in effect unintentionally overdosing on a combination of benzos and opioids?

MACKEY: Absolutely, people are taking these by and large without the intent of trying to hurt themselves. But the unintended consequence is that with the combination of these medications, it's causing an increase in the respiratory depression affects. In other words, it's slowing down your breathing even more than any of the agents just taken alone. And it's that combination that is really running people into problems.

CORNISH: So in a nutshell, what did your research find about the role of primary care providers in this?

MACKEY: There is this relatively dramatic increase in the prescribing of benzodiazepines alone over the last seven to 10 years. But in addition, there is a dramatic increase in the co-prescribing of benzodiazepines with opioids over that same period of time. And I think that's where we have most of the concerns.

CORNISH: But to be clear, it's not always dangerous to be taking both classes of medication.

MACKEY: Yeah, absolutely. And I see story after story after story about the patient who has, for instance, chronic pain, who may be taking a benzodiazepine for a generalized anxiety disorder. And I'm the majority of the cases it's not running them into problems.

I'll share with you, in my practice, I tend not to prescribe both of these together. And I tend to get people off of the benzodiazepines. But I also know that the answer is not so simple as that. But there are scenarios where a person would benefit from being on. If you're going to be on both of these together there should clearly be increased vigilance, and ideally to try to find non-medication ways of managing these problems.

It's going to be finding appropriate psychological therapies and getting those paid for, to help people deal with the underlying anxiety disorders, or PTSD. It's going to be physical therapy and mind-body and psychology and other approaches to help people with chronic pain. And it's not that these approaches are going to cure everything. But using those approaches, we may find that it helps reduce the use of these medications, and therefore reduce the risks.

CORNISH: What, if anything, should patients understand about the dangers?

MACKEY: First, that we need to recognize that were vast majority of patients these medications have been used safely. There is a cost though for a vulnerable group of people who may misuse these medications, abuse them, become, frankly, addicted to them. And we need to do a better job in educating them about the potential risks of that. And we need to do a better job in educating the prescribers to keep their eyes open and recognize those risk factors.

CORNISH: That's Dr. Sean Mackey. He is the chief of pain medicine at the Stanford School of Medicine and also president of the American Academy of Pain Medicine.

Thank you so much for speaking with us.

MACKEY: Thank you. Transcript provided by NPR, Copyright NPR.

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