Strongest FDA Warnings Out on Opioid, Benzodiazapine Risks

The Food and Drug Administration (FDA) has issued its strongest warnings that prescription opioids and benzodiazapines pose major risks to users, especially if they are taken together or in combination with alcohol.

In a notice published at http://www.fda.gov/Drugs/DrugSafety/ucm518473.htm, the FDA told health care professionals to stop prescribing opioid cough medicines for patients taking benzodiazapines -- or other depressants of the Central Nervous System (CNS) including alcohol. They should prescribe opioids for pain only when other treatment options are inadequate.

Opioids — such as codeine, hydrocodone (HYSLINGA, NORCO, ZOHYDRO) and oxycodone (OXYCONTIN) — are widely prescribed for pain and cough. Benzodiazepines — such as diazepam (VALIUM) and alprazolam (XANAX) — are often used for anxiety, insomnia, seizures, and sleep problems.

Combinations of these drugs can cause extreme sleepiness, slowed or difficult breathing, coma, and death, the FDA said. Get details at the web site, and be sure to scroll down and click up several additional pages which explain the risks and list the dozens of opioids and benzodiazapines on the market.

The FDA said it now requires black-box warnings -- its strongest warnings -- on the dangers of combining opioid pain medications with benzodiazepines. Public Citizen’s Health Research Group lists most opioids as "Limited Use," noting that they are overprescribed and can be addictive. They list most benzodiazepines as "Do Not Use," with the exception of alprazolam, which is Do Not Use except for panic disorder.

Interested in more discussions like this? Go to the Chronic Pain Support Group.

@babs10

I was prescribed klonopin for 25 years after a divorce. I could not sleep, had 2 little kids, was in counseling and this is what was prescribed to help with sleep and anxiety. I appreicated it so much - it was magical - I slept like a baby and it reduced my anxiety to nothing. Much much later, I read about the side effects and the impact on the brain and found a doctor to help me safely taper and it took me over a year to get off of it. I notice significant memory loss and I'm 100% sure that most of that is from the drug (some due to age, I'm sure). I wish I'd even heard of it and don't understand why it was so freely prescribed year after year. If a doctor prescribes it, it's important to understand the side effects and to know how long it's safe to take it - I believe it's no more than 4 weeks.

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Another side of the coin. I took Xanax for 25 years before tapering off. No memory loss and I’m 72.

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@sears

Another side of the coin. I took Xanax for 25 years before tapering off. No memory loss and I’m 72.

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Wow, how fortunate you are! Now people have both ends of the spectrum and will decide for themselves!

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Did you have a hard time weaning. Im on and off benzos bc of anxiety and sleep. Developed dependence so try to cut back

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@babs10

Wow, how fortunate you are! Now people have both ends of the spectrum and will decide for themselves!

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I don’t feel lucky because it’s has never been proven that benzodiazepines cause permanent memory loss. All studies have been inconclusive.

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@brendaharvey

How safe is .5 Xanax 3 X daily?

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I was taking 2, one in morning and one at night. After noncompliance with a substitute physician not filling script as she said she would, I went into withdrawals. It was horrible. Went to hospital 2 times within a 24 hour period. Tried to tell them that something neurological was going on. Everything smelled like cheap men's cologne. Threw out milk because it smelled bad. Did not eat for 5 days and PHYSICALLY could not sleep for over 48 hours. It was simply horrible. It was my sister, who is a doctor, that asked me when was the last time I had my xanax and I said 2 days ago and she said Carol you're having withdrawals you need to get that medicine ASAP. Finally got the nurse manager to call them in. Within 3 minutes of taking that pill I was back to normal. I then started with 1 in the morning and a half in the pm for about 3 months. I then went to 1 a day, in the morning, for about 1 month and then I did half in morning and half in afternoon. I am now at a quarter, half of a half mg tab. I have anxiety very bad but the quarter mg seems to work except when we have a severe thunderstorm or hurricane then I must take a whole one. So a 30 day supply actually lasts about 3 months. I also take hydrocodone for chronic back issues. Just had another MRI, last one was in 2020, and it shows changes. Internal vibrations are from a nerve being pinched in lower back that causes both thighs to go numb if I stand in one place too long. That's one reason I had to go on disability at 63, 3 years ago. I take my pain meds every 6-8 hours and have for over 20 years. They still do their job. I could easily go back to 2 xanax a day but since they are fast acting I can take them when the situation calls for it. I will never have withdrawals again.

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@gailb

@stfnwtl89

Welcome to Mayo Connect. I am a Volunteer Mentor and not a medical professional. We don't make medical diagnoses nor do we give medical opinions. We do offer our own experiences with medical issues in order to give others alternatives to their personal medical choices.

As an older adult (68 yrs.old at the time) I was put on several pain medications for chronic back pain that became acute pain in October, 2016. I am already taking Citalopram (SSRI) to which my pain doctor added Gabapentin, Baclofen, and Tramadol. I was also given a prescription for Valium to take before my back surgery in December, 2016. I continued to take these medications until I was beginning to feel better as a result of a new physical therapy I was trying called Active Release Therapy (ART). When I told my pain doctor I wanted to stop taking the Gabapentin (600-900 mg/day), he seemed to be mad at me and asked me why. I told him I didn't like the way I felt on it, couldn't think straight and was losing large chunks of memory. (In fact, I thought I was getting Alzheimers it was so bad.) When he said I could just stop taking it, I said I had read that you can have withdrawal symptoms if you just stop it. He laughed at me and said impossible. Then I got a lecture on what was "withdrawal" and that I could only have that from opiods, not Gabapentin. However, I had read on Mayo Connect about the problems withdrawal from Gabapentin caused people. I then called my pharmacist who gave me a withdrawal schedule and confirmed that it was difficult to withdraw from. I successfully withdrew over 2-3 months time. I also withdrew from Baclofen at the same time toward the end of the 3 months. I discovered that my pain improved as I withdrew from the Gabapentin.

I was still taking Tramadol 50mg 4x day until November, 2017. I talked to the pain doctor about withdrawing from it as well, and he encouraged me to do that. It was much harder do withdraw from, and I still have some issues that I attribute to withdrawal. It has taken me 3 months to get off the Tramadol. I found that CBD Living Water and drops helped with my anxiety during withdrawl at the beginning. CBD is from marijuana and is the part of the plant that doesn't make you high. It helped me relax and relieved anxiety. I no longer use it. My pain doctor cut the number of pills in my prescription to 3 a day, and I began cutting those in half as I was going down in dose. I just got a refill of Tramadol and asked the doctor's office to only give me 30 pills as I would only need them now if I have acute pain, which happens only occasionally if I overdo it. However, they gave me the 90 pills again. If I was still feeling addicted to Tramadol this would have been a detrimental thing for me. Fortunately, I have just put the pills away and will not take any unless I really feel pain. Even then, I will only take 1/2 a pill.

It is hard to believe that pain doctors, especially, don't want you to get off drugs. Knowing what I know about Gabapentin now after taking it, I would recommend anyone taking it to withdraw, but that is only my experience. Others may find great help with it. What I have learned is to pay attention to my body, and if I think there is a problem with what my doctor tells me, find another source to investigate the information. I have successfully withdrawn from my medications, but I wasn't taking them for many years.

I recommend that anyone withdrawing from opiods/benzos talk with your doctor, but also with your pharmacist about what they recommend as a withdrawal schedule. If you are having withdrawal symptoms that are too much, go back to your previous dose, and take it slower. None of these drugs is easy to get off,and it takes a long time to do so. Take as long as you need, many months, and cut your doses in half or by quarters to help you with the slow withdrawal. By all means I recommend from my experience, try CBD to help with the anxiety you will feel. It is not addictive and if it's legal in your state, I found it very helpful.

I agree with you that in their efforts to find a way to help relieve pain, doctors have gone to the extreme in prescribing opiods as an easy "fix". I watched my older brothers go from light use to morphine and oxycontin, and now methadone in the pain doctor world. We have genetic back disease, but just treating the pain with medications isn't where things should stop. My discovery of ART has relieved my pain almost completely. I have pain but it is bearable, and if needed I take Tylenol first (following instructions), and that usually works. My youngest brother has gotten off oxy after many years of taking all kinds of drugs for pain. He had back surgery fusing two disks 2.5 years ago and though he still has pain, it's reduced and he's living with it.

I think we've all, including doctors, been misled about opoids and benzoprines. Money is a strong driver of corporate actions, and I believe that is the case here. I know to listen to my body and be very careful what I put in it. Doctors, pharmaceutical companies, and pharmacists are human beings. As such they make mistakes. In my opinion, our mistake can be listening to their advice at the expense of our own intuition about our bodies. They do the best they can,and I must do the best for myself as well.

How have you been handling your family member's withdrawal symptoms now?
Have you spoken to any pharmacists about helping with the schedule of withdrawal?
Please let us know where things are with them and with you. Thank you for sharing your thoughts and frustrations with us. I hope my experience is helpful.

Warm regards,
Gail B
Volunteer Mentor

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What do you reccomend for pain after withdrawal of gabapentin and tramadol

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@sotnick1

Did you have a hard time weaning. Im on and off benzos bc of anxiety and sleep. Developed dependence so try to cut back

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I'm down to a quarter mg daily from 1mg. I had half mg tabs and took 1 in AM and 1 in PM. Then went to 1 in AM and a half in PM for about 3 months. Then went to just 1 daily but did half in AM and half in PM for about 3 months. I'm now at just the half in the AM. I mainly need them before trips on the interstate, thunderstorms and hurricanes. Since retiring I don't have the stress and anxiety that was work related. They are to keep anxiety level down because I have heart palpitations too.

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@carol1024

I was taking 2, one in morning and one at night. After noncompliance with a substitute physician not filling script as she said she would, I went into withdrawals. It was horrible. Went to hospital 2 times within a 24 hour period. Tried to tell them that something neurological was going on. Everything smelled like cheap men's cologne. Threw out milk because it smelled bad. Did not eat for 5 days and PHYSICALLY could not sleep for over 48 hours. It was simply horrible. It was my sister, who is a doctor, that asked me when was the last time I had my xanax and I said 2 days ago and she said Carol you're having withdrawals you need to get that medicine ASAP. Finally got the nurse manager to call them in. Within 3 minutes of taking that pill I was back to normal. I then started with 1 in the morning and a half in the pm for about 3 months. I then went to 1 a day, in the morning, for about 1 month and then I did half in morning and half in afternoon. I am now at a quarter, half of a half mg tab. I have anxiety very bad but the quarter mg seems to work except when we have a severe thunderstorm or hurricane then I must take a whole one. So a 30 day supply actually lasts about 3 months. I also take hydrocodone for chronic back issues. Just had another MRI, last one was in 2020, and it shows changes. Internal vibrations are from a nerve being pinched in lower back that causes both thighs to go numb if I stand in one place too long. That's one reason I had to go on disability at 63, 3 years ago. I take my pain meds every 6-8 hours and have for over 20 years. They still do their job. I could easily go back to 2 xanax a day but since they are fast acting I can take them when the situation calls for it. I will never have withdrawals again.

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Difficult to stay away from that stuff when one suffers from severe and chronic pain.

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Is it dangerous if you are taking tramadol and lyrica and you have to have surgery with the anesthesia?

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@kenc

Difficult to stay away from that stuff when one suffers from severe and chronic pain.

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I wouldn't say difficult to stay away from. That makes it sound kinda like I have a choice. 🤣
I did back breaking work working with elderly clients in an assisted living facility. I owned the salon there for 20 years. All the lifting, supporting, tugging for so long finally took its toll. I was devastated when I was forced to stop working. I'm just thankful the pain meds still do their job. The xanax I started after I had a sub-arachnoid hemorrhage (brain bleed) in 2011 and was in ICU at Shands in Gainesville FL for 8 days. Side note...I only missed 2 weeks of work too. One in Shands and 1 the doctor made me take off. Lol
I was very lucky that I didn't need surgery. I could have taken a year, per the doctor, but I questioned why a whole year but quickly learned I needed that long to fully recover. I still showed up for work though, yes I LOVED my job. 🤗
I will most likely stay on the pain meds because that situation won't get better without surgery and I honestly don't want that. As long as the anxiety is managed by the lowest dose possible, the quarter mg except in situations that calls for full dosage, I can live with that because if I stopped the xanax today, I would not experience withdrawals at all.

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