Two of a Kind
Opioids have been a crucial part of pain management in medicine for decades. Morphine specifically has been around since the turn of the 19th century as a synthetic drug derived from the opium plant. It has a history of use in pain management for surgeries and battlefield trauma. Today, much more potent opioid drugs, including the dangerous fentanyl, are available. However, all modern opioid varieties are usually compared to morphine as the gold standard to compare and contrast their strength. Between the 20th and 21st centuries, opioids were so widespread that more than 2.5 million people were struggling with addiction by 2015. A large part of this addiction epidemic was the marketing of the drug OxyContin.
Benzodiazepines have a history of treating anxiety, insomnia, muscle spasms, and panic disorders, although their history is more recent than opioids. In fact, benzos were marketed as a safer alternative to the problematic barbiturate drugs that had unfortunate abuse and addiction potential. Unfortunately, benzodiazepines were heavily marketed and prescribed worldwide, eventually topping over 135 million annual prescriptions by 2013.
The FDA’s Black Box Warning
By 2016, the FDA stepped in to update its labeling requirements for opioids and benzodiazepines, assigning its black box warning to more than 400 prescription medications. This warning is the agency’s most significant warning about drugs with a high potential for abuse and/or death. However, this alert was not restricted to the use of these drugs in isolation; it also carried additional warnings for combined use.
This initial warning mentioned how opioids and benzodiazepines are central nervous system (CNS) depressants, a class also shared with alcohol. The reason this point is so important is that people using these drugs could be under the assumption that since these drugs are different, they are safe to use together. However, CNS depressants of any kind, when used together, can cause a CNS depressant overdose. For example, wine and beer are different types of alcoholic substances, but alternating between the two is not a safe method to keep from intoxication.
Among the black box risk, details include the communication that combined use could lead to difficulty breathing, coma, and even death. With both drugs in high demand and millions suffering from either benzo or opioid addiction in the 21st century, the percentage of combined use was high enough that the FDA deemed it necessary to send out this warning.
While this communication was significant on its own, the FDA updated its warning information yet again in 2017, insisting that the risk of combining these drugs was still very high. However, the benefit of using these two drugs together in a controlled medical environment should not be avoided entirely. However, the risk of mixing benzodiazepines with prescription opioid cough medication is such a threat to breathing and consciousness that even health care professionals are advised to avoid mixing these drugs together at any time.
This updated warning teaches us two things. First, it teaches us that the FDA considers mixing benzos and opioids so dangerous that only health care professionals should do this and heavily monitor their patients at that. Secondly, there are even stipulations given to health care professionals and limits to the scenarios valid for combined use, such as “to patients for whom alternative treatment options are inadequate.” With those two points in mind, general use, recreational use, and avoidable combination of these two drugs are too dangerous to risk at any time whatsoever, per the FDA’s safety communications.
Maintaining Safety
When we take the FDA’s messaging seriously, we should consider how dangerous it is to combine these drugs. On the one hand, we’re reminded that the FDA releases communications only after pulling much data and research together and analyzing it. In other words, there are sad statistics to back up the warnings coming from the FDA. But on the other hand, we can see just how necessary it is to seek treatment if you or someone you know is struggling with benzo addiction, opioid addiction, or a combined substance use disorder of the two.
