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Double Trouble: Benzodiazepines and Narcotic Pain Relievers

What do you do when you discover that someone you love is abusing not just one substance but two? Over the past decade, the number of people who felt the impact of that shocking revelation actually quintupled. From the year 2000 to 2010, annual cases of those battling addiction to both benzodiazepines and narcotic pain relievers increased from about 6,000 to almost 34,000. That’s quite a jump!

Benzodiazepines include the drugs used to combat generalized anxiety disorders, panic disorders, and agitation. The most familiar medications include Valium, Librium, Xanax, and Tranxene. Some “bennies,” as abusers affectionately call them, have been used as muscle relaxants. Some doctors prescribe them to relieve the symptoms of alcohol withdrawal or insomnia.

Narcotic pain relievers (NPRs) are prescribed for people who are recovering from muscle pain caused by some kind of trauma or illness, joint pain from arthritis, or the common pain of postoperative recovery. Most commonly prescribed medications include Tylenol with Codeine, Vicodin, Percocet, and OxyContin. They all are morphine or codeine derivatives.

Dosage issues for these NPRs include a tolerance that quickly develops; the patient might soon request a higher dose. They are also very addictive, and once someone begins a course of therapy he may find it very difficult to stop taking this medication.  With benzodiazepines, they stay in the system longer in older patients; someone who took Valium in his 20s will have more difficulty shaking it off if he’s still using it when he’s in his 50s.  Both types of medications are very dangerous for people who drink alcohol.

Some patients present with interrelated problems—a person who suffers an auto accident may well develop anxieties during his recovery process, for example. A common scenario involves a patient seeing an orthopedic doctor for joint injury, for example, and then visiting his family physician for help in dealing with related anxiety.

Statistics from the Substance Abuse and Mental Health Services Administration (SAMSHA) in a study of people with this dual addiction show:

  • Non-Hispanic Whites in the 18-34 age group were the largest population segment taking this combination, with men and women equally affected. The average patient age was 31.2 years. 
  • 38 percent began taking both medications in the same year.
  • Of the remaining 62 percent, 34 percent began first with the benzodiazepine medication; the other 28 percent started with the NPR.
  • Just under 50 percent of those taking both medications had a co-occurring mental health diagnosis—such as anxiety or panic disorders.

But the most significant statistic is the shocking increase in treatment admissions for benzodiazepines with NPR addiction compared to other addictions. The benzodiazepine/NRP group increased 569.7 percent in the decade between 2000 and 2010. For that same time period, admissions for all other addictions rose 9.5 percent.  While an increase in either type of admissions is bad, the huge difference between the two numbers reveals the alarming increase of benzo/NPR abusers.

What should you do if someone in your family is taking this deadly combination—or what if it’s you? The good news is that of those who sought treatment, few of them were referred through the criminal justice system. That means abusers are accepting the realization that an addiction issue has developed.

The bad news is that someone who takes both benzodiazepines and narcotic pain relievers has dual withdrawal problems. He or she not only has to deal with the anxiety of withdrawing from medications that were helping him but also with the underlying emotional or mental health issues that led him to taking the benzodiazepines in the first place. In addition, withdrawal from benzodiazepines can worsen the symptoms of withdrawal from narcotic pain relievers.

Addiction treatment specialists are seeing an increase in treatment admissions for people who want to kick this dual addiction, and almost half of them are self-referrals. Armed with the knowledge that these patients come with treatment-resistant problems, counselors are successfully working to engage them in recovery. 


SAMSHA. Admissions Reporting Benzodiazepine and Narcotic Pain Reliever Abuse at Treatment Entry, published 12/13/12 http://www.samhsa.gov/data/2k12/TEDS-064/TEDS-Short-Report-064-Benzodiazepines-2012.htm

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