Midstate doctors: FDA’s deadly pill combination warnings a good step

YORK, Pa. (WHTM) – New guidelines about prescription drugs from the Food and Drug Administration — intended to save lives — are a good first step, Midstate advocates say.

But the problem of mixing opioid painkillers and benzodiazepines (commonly prescribed anti-anxiety pills like Xanax) is a complicated one to solve.

The FDA is now requiring warnings on both types of medications about the dangers of taking them together.

The mandate comes as the medications are increasingly prescribed together, a potentially deadly combination. The number of patients getting both jumped 41 percent between 2002 and 2014, the FDA found.

Opioids were the focus of a legislative hearing Thursday at the York County School of Technology. Lawmakers from around the state gathered to listen to and discuss the crisis with doctors, caregivers, and recovering addicts.

But the FDA is identifying a different problem: how those drugs interact with benzodiazepines.

“I’ve had a lot of problems trying to get people off of the benzos along with the opioids,” Christina Martinez, an addiction counselor and recovering addict, said. She sees the combination a lot. “It’s all about fear,” she said.

She describes to her clients the dangers of continuing to use benzos while on opioids, she said, but they worry, “‘How am I going to feel without it?'”

Both drugs depress the central nervous system. Together, they can slow your breathing, put you in a coma, even kill you.

“I would say a large portion, significant portion of our overdoses in general involve mixing those two,” York County coroner Pam Gay said.

The FDA said in announcing the new rules that overdose deaths from taking both drugs tripled from 2004 to 2011.

The agency is now requiring boxed warnings — their “strongest warning” — on nearly 400 opioid and benzo products that detail the harm of taking the pills together.

But it appears one group is more at risk than others.

An analysis by the Washington Post found between 1999 and 2014, yearly opiate overdose deaths among middle-aged white women jumped 400 percent.

That’s about 54,000 deaths over 15 years, the Post reported; benzos contributed to at least a third of those.

Even more striking, the analysis found, those women were far more likely than other races to be prescribed both opiates and benzos — and five times more likely to get the combination than white men.

“Women go through different phases of their life,” Dr. Susan Peck explained.

Peck, an OBGYN in Hanover, has for the last seven years worked with pregnant women who are addicted to opiates. Having kids, perimenopausal hormone changes — benzos help with all that anxiety.

“Now they have a surgery, they have an injury, and it’s opiate-level medication that they need for their pain,” Peck said.

It can go the other way, too. “When it comes to pain, the opiate comes in,” Martinez said. “Well, with any pain, you have anxiety about it.”

Whichever way it starts, Peck said, it’s difficult to get her patients to stop taking their anti-anxiety medication, even for health reasons. She recommends other coping mechanisms like yoga and behavioral therapy, but those take time to learn.

“If you know that you’ve got something that you slip under your tongue that’s going to help you not have a panic attack, not have an anxiety attack, you’re very reluctant to give this up,” Peck said.

Another issue, medical professionals say, comes when two different doctors prescribe the medications. Each might not know about the other.

“Doctors need to be cognizant of whether or not that person in on opioids when they prescribe the benzos or vice versa,” Gay said, adding she hopes the state’s new prescription drug monitoring program will help.

But all that uncertainty, that lack of communication, can lead to major problems that the FDA is hoping to solve.

“I think that that is a great step,” Martinez said, “because they’re both hard to get off of.”

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