When deaths from overdoses from opioid painkillers occur, there are usually other prescription medications for mental health disorders and/or neurologic conditions involved too, researchers from the Centers for Disease Control and Prevention (CDC) reported in JAMA (Journal of the American Medical Association).

The authors had gathered and analyzed CDC data involving deaths from overdosing on opioid painkillers. They found that in 30.1% of deaths, patients had also taken benzodiazepines.

Benzodiazepines are popular psychiatric prescription medications, and include such names as Ativan (lorazepam), Klonopin (clonazepam), Xanax (alprazolam) or Valium (diazepam). They are commonly prescribed for anxiety problems, as sedatives, and anticonvulsants (for epilepsy). Benzodiazepines are also muscle relaxants.

Leonard Paulozzi, MD, who works at the CDC in Atlanta, Georgia, and team wrote:

"This analysis confirms the predominant role opioid analgesics play in pharmaceutical overdose deaths, either alone or in combination with other drugs. It also, however, highlights the frequent involvement of drugs typically prescribed for mental health conditions, such as benzodiazepines, antidepressants, and antipsychotics in overdose deaths."

NCHS (National Center for Health Statistics) data revealed that the number of people dying from drug overdoses progressively rose for an 11-year period through to the end of 2010, with prescription opioid painkillers being the main drive behind the increase.

Healthcare professionals and public health authorities have known that opioid overdose deaths are usually linked to other medications, but nobody knew exactly what type of other drugs were involved, and in what proportions.

After assessing data on multiple cause-of-death from the National Vital Statistics System, Dr. Paulozzi and team identified 38,329 deaths in the USA caused by drug overdoses. In 58% of these deaths, other medications were involved.

Of the pharmaceutical-related deaths from overdose, 74.3% were unintentional and 17.1% were intentional (suicides), while 8.4% were of "undetermined intent".

Among deaths caused by prescription drugs, the most commonly found medications (either in combination or on their own) were:
  • 75.2% - opioids
  • 29.4% - enzodiazepines
  • 17.6% - antidepressants
  • 7.8% - drugs used for epilepsy and Parkinson's disease

Opioids present in many deaths involving other drugs

Opioid analgesics were also present in the following deaths involving other medications:
  • In 77.2% of benzodiazepine deaths, patients had opioids in their system
  • In 65.5% of anti-epileptic and anti-parkinsonism drugs, patients had opioids in their system
  • In 58% of antipsychotic and neuroleptic drugs, patients had opioids in their system
  • In 57.6% of antidepressants, patients had opioids in their system
  • In 56.5% other analgesics, anti-pyretics (drugs to reduce fever), and anti-rheumatics, patients had opioids in their system
  • In 54.2% of other psychotropic drugs, patients had opioids in their system
The authors concluded:

"This analysis confirms the predominant role opioid analgesics play in pharmaceutical overdose deaths, either alone or in combination with other drugs. It also, however, highlights the frequent involvement of drugs typically prescribed for mental health conditions such as benzodiazepines, antidepressants, and antipsychotics in overdose deaths. People with mental health disorders are at increased risk for heavy therapeutic use, nonmedical use, and overdose of opioids.

Screening, identification, and appropriate management of such disorders is an important part of both behavioral health and chronic pain management.

Tools such as prescription drug monitoring programs and electronic health records can help clinicians to identify risky medication use and inform treatment decisions, especially for opioids and benzodiazepines."

In November, 2011, the CDC reported that more Americans died form prescription painkiller overdoses than all deaths from cocaine and heroin combined.

New York Mayor, Michael Bloomberg, introduced new emergency room guidelines to prevent opioid prescription painkiller abuse in January 2013. In 2010, there were 143 painkiller-related emergency department visits per 100,000 people in the city, compared to 55 in 2004 - a 2.6-fold increase.

Written by Christian Nordqvist