Strongest FDA Warnings Out on Opioid, Benzodiazapine Risks

Posted by Martin Jensen, Volunteer Mentor @predictable, Nov 2, 2016

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.

kenc | @kenc | Nov 25, 2024

In reply to @ruthblaze "What do you reccomend for pain after withdrawal of gabapentin and tramadol" + (show)

Depends on the cause of the pain.

bunstuffer | @bunstuffer | Nov 25, 2024

I understand the dangers of these drugs but I have valium, hydrocodone and cyclobenzaprine in my medicine cabinet. My doctor monitors these closely. I know better than to take these together. I have been to 8 doctors including 3 pain centers one at teaching hospital with no relief for pain in my back, hip and thigh. I can't take Cymbalta or tricyclics because of severe side effects. Cymbalta(30mg) landed me in the hospital with serotonin syndrome and low blood sodium. Gabapentin(100mg) made me fall but didn't relieve my pain. Tricyclics made me vomit. I've tried other things also. I've had difficulty tolerating medicine since I was a child. I guess we all have to do what works for us as individuals. I'm about 4 hours from Rochester but have no way to get there. I drive but don't feel comfortable driving that far alone anymore.

suzfuse46 | @suzfuse46 | Nov 26, 2024

I am wondering how many of you out there have sensitivities, allergies and adverse reactions to many types of medications that are prescribed for chronic pain, like antidepressants, antiseizure, NSAIDs, antispasmodics and DMARDs. It seems like if you have any G.I. issues like gastritis, GERD, diverticulosis or IBS or Sjogren's, you are not going to do well with many of the medications prescribed to try to relieve the pain. It would be interesting and beneficial to know if this is a common problem among chronic pain patients so that we wouldn't face the doubt of prescribers that these sensitivities exist. IMHO - we really need a research study to investigate this.

tammy1977 | @tammy1977 | Nov 26, 2024

I agree, ill be following to see answers you receive

mackaymouse | @mackaymouse | Nov 27, 2024

In reply to @suzfuse46 "I am wondering how many of you out there have sensitivities, allergies and adverse reactions to..." + (show)

I can't take NSAIDS,they make me bleed internally. I have multiple allergies! There are so many side effects from medication that I take but I keep telling myself that it's better than the symptoms.
I believe you, there has to be a link.

cheryl46 | @cheryl46 | Dec 7, 2024

In reply to @gailb "@stfnwtl89 Welcome to Mayo Connect. I am a Volunteer Mentor and not a medical professional. We..." + (show)

@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

Jump to this post

Thank you Gail for your supportive words.
I take Clonazepam for Achalasia, surprisingly it is the only thing that relaxes my chest pain related to esophageal spasms. I take 1mg sublingual as needed.
For the past 2 years I've suffered with cervical cord compression and have been in horrible pain. Literally it has changed my quality of life. I have done PT, facet injections, epidurals, and nerve ablation with no relief.
Lastly, Gabapentin causes me to have severe depression, can't take any type of NSAIDS due to GI issues, Tramadol does nothing 🤷‍♀️
That all being said, I am unable to get any pain medication for all the above. I know the effects of benzodiazepine and opioids taken together, which I would never do but when you can't even ride in a vehicle without having pain with every bump in the road then what are the options?