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.
I am curious, now after years of over prescribing medications with little known facts about their consequences what is being done to help the people who trusted the fda, pharmaceutical co., and Dr.'s above all who put these drugs into circulation. I personally have dealt and am dealing with family member/s who are now up in years, 65+ that have been on opiod/benzo combo for years 20+ for 1 family member chronic pain/depression, 1 family member anxiety and for the 3rd I am not quite sure just why he is being prescribed the medication. Now, 1 family member has passed away, the other is under care of psychiatrist, and the 3rd is under care of pain mgt. clinic who after 2 years of pain mgt. has decided to wean 68yr old from benzo's and opiods all at same time, over the course of 2 months have been to ER twice. 1st they administered benzo and sent home or offered Bradford. 2nd trip withdrawals were worse and admission to geriatric psych unit (most heart wrenching and disgusting vile place I've seen removed all meds and psych dr. wanted to treat with depakote and venlafaxin, after 2 days paranoid, hallucinations etc…, another family had same situation after 1 week they said there mom came in walking and talking on her own by day 6 she could not stand on her own and could barely formulate a complete sentence. I left with my family member and called the pain mgt clinic and we are now on round 5 of tapering and withdrawals. So I am curious now we have the warnings for future generations that is GREAT, but what about the generation who have been used as lab rats and are now suffering due to this epidemic of benzo/opiad abuse. The Dr.s say one thing and you should follow this for tapering/weaning this is what to expect, but then look at the messages contained on this website and others the people who are going through this are saying something else and everyone's withdrawals are different. There seems like little to no help and not everyone can afford to check into a treatment facility in california overlooking the ocean. And Bradford treatment center is not equipped to deal with someone who has a chronic pain condition such as facial or trigeminal neuralgia. So my question is what about the generation who have been used as lab rats, now where do they go from here? This is time lost from work, strained family relationships, and it seems like for everyone 1 positive there are 3-5 negatives. What have we gained by sending someone 65+ into benzo/opiad nightmares there are tons of families dealing with this. It seems like with medications the FDA needs to be regulated and drugs need to be tested more than what they are a.) for longer periods of time and b.) on more diverse groups of people. Any thoughts?
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.
@gailb, you are spot on as far as my experience with gabapentin. I was taking 3000mg/day and my Dad's (who had dementia) neurologist told him to stop taking it as it was making his memory worse. I decided then that I had never felt that it offered any relief at all and started tapering down until I was off of it. I still have to take opiates for my chronic pancreatitis pain, but I am tapering off my extended release dilaudid/morphine and just trying to get by with the fast acting for acute pain. My brain fog improved by at least 75% when I dropped the gabapentin and I don't notice anywhere near that affect cognitively with opioids. My new psychiatrist did say that I should not be taking benzodiazapines with opiates as both slow your breathing to the point where you could just stop. I was already aware of this and as I wear a BiPAP, I would put my mask on when i was medicated to the point of wheezing. The benzo's are more difficult to stop than opiates for me, but I think it is my familiarity with the w/d symptoms from opiates. I have read a good number of people who feel that gabapentin helps with their neuropathy pain and I can only hope that it treats different people in different ways cognitively. Has anyone else had the same experience or better ones with gabapentin? What about discontinuing taking it?
Medical schools have taught this for many years, but you go to the pain management doc and they prescribe opiates for pain that will not respond to anything else. Then you get depressed and anxious because of chronic pain and the opiates and your psychiatrist prescribes benzo's because your symptoms won't yield to anything else and they both conveniently forget that you are taking the other drug. Everything I have read about benzo's warns that they are only to be used short-term (maximum of 12 weeks) to treat anything. I am glad I began seeing a new Psychiatrist who wanted me off the benzodiazipine.
We have tried working with pharmacy and dr and even hospital dr says if can't work thru withdrawal he is going to refer elsewhere, pharmacy only fills the prescription and seems judgemental because the regiment of prescription keeps changing. The last 2 months have been awful, heartbreaking and frustrating. We've been going to dr. every 7 days and nothing is working. We are talking 10+ years of benzo and opiods for chronic pain mgt, I want to help desperately but there seems little to know help and no answer just more questions and more medicine combinations. I wonder how much more a body can physically and mentally take.
An elderly woman I knew quite well died in 2006, still addicted to Lorazepam, a benzodiazepine originally prescribed for her when her husband was mortally burned in a home fire in 1980. For those 26 years, she remained addicted although her emotional health had been restored and stabilized within months of her husband's death. A series of personal care physicians provided her Lorezepam prescriptions every time she requested them . . . for 26 years. This is my personal experience with benzodiazipines — and the cause of my personal resolve never to take the damn stuff!
@perdictable When I worked in community mental health as a counselor our psychiatrists would give us training about psychotropic medicines and they told us that none of them were intended for long-term use. 19lin
I was prescribed Lorazepam years ago (at 27 yrs. Old during my divorce) for my anxiety/panic attacks. I really only took them when I needed to fly for my job or for vacation. I had a few times when I had particularly bad panic attacks and took the pills. Fortunately, I never liked how I felt on them or the "hangover" I had after 8 hours or so. I usually just waited through my anxiety or panic, using Yoga breathing to calm down. I knew they only lasted about 20 minutes and that I wouldn't die from the anxiety. When I adjusted to Citalopram 6 years ago, I noticed that I no longer had anxiety or panic attacks. I flew to Costa Rica & Panama, and even zip lined down 7 lines with no anxiety or panic. I felt so free from my old fears, and it is due to the antidepressant.
Since Tramadol also affects your SSRI, I'm a little concerned that I may have anxiety when we fly to Tahiti in a month. I say this only because I had a lot of anxiety when withdrawing from the Tramadol. I used CBD derivative from marijuana to help me calm down as I had a lot of muscle tremors as well as anxiety and was not able to think clearly at the time. It was very helpful. I no longer use it, but will again if I experience a lot of anxiety for some reason. It is not addictive for me at least.
We'll see how well I do with flying 8 hours in the plane. At least I think Tahiti as the destination will be worth it! This is my husband and my long overdue honeymoon completion. When we married 35 years ago we had planned to go to Tahiti, but went only to Hawaii instead, due to work and other responsibilities. Now that we're retired and he's 72 and I'm 69, we are having our honeymoon in Tahiti.
@stfnwtl89, I recommend that you try to get an appointment with a Mayo close to you. They have many good programs to address pain and withdrawal. The withdrawal process takes a very long time, as much as a year. Also, some people are on these medications because they truly need them. Its possible that your family member will always need these drugs. My understanding is that our bodies and brains change when we take opiods. The opiods replace the normal pain reactions in our brains, and it takes time to rebuild those brain pathways to handle pain normally. That's why we become addicted to the drugs. That's why it takes a very long time to slowly withdraw from them.
I don't know what your doctors are doing that is causing you to have to see the doctor every 7 days, but it indicates to me that your family member is trying to withdraw too fast. To do that requires hospitalization and medical help. I actually don't think that's a good way to withdraw. My brother did that twice, and ended up back on the oxy shortly after each time. The last time, after his back surgery, he decided to withdraw slowly. This time it has worked and he's been clean for about 2 years now. He was on these opiods for over 10 years as well.
I hope you find relief for the situation. Perhaps others on Mayo Connect can tell you more about the withdrawl programs through the Mayo Clinic.
Thank you for speaking with me today and I really appreciate this site, I just checked and the closest mayo clinic is 212 miles away which is not out of the question but would definately take some planning on my end as I am caretaker for both of my parents. Not out of the question just wish there were closer options. We are going to the Dr. every 7 days because he keeps changing her medications due to reactions and pain level response, I suggested 2 weeks was too long with all the adjustments being made because the withdrawals start immediately anything less than 1mg of xanax 3xd has the following effect. Day 1 mindset is this can be done stays up listening to gospel music, Day 2 can't sit still, will not be able to sleep and internal itching begins, speech is rapid and thoughts are scattered zips from this to that organizing, cleaning and all over the place, stays up listening to gospel music for therapy again no sleep Day 3 by 10am mood starts changing irritation, journaling begins to relieve anger building by 12-12:30pm full blown anger at everyone self, dr.'s, family and so on. It progesses to day 4 paranoid, people are trying to hurt etc. no sleep again, day 5 gets out of control and the past couple of times wound up at hospital ER which none of the hospitals seem to have adequate treatment for this as I stated earlier Bradford is not the place for someone with Chronic pain, day 6 we make a flying trip back to pain Dr. who is aware of all the symptoms and what has transpired but has other patients and can't work you in until today, then we explain too much has been taken away at 1 time and the dosage is increased but then something else is decreased or removed, effexor was removed this past time and percocet was increased and xanax was decreased from 1mg 3x per day to .5 mg 3x per day. We are on day 3, this time the follow up appointment is for 14 days, that will never happen. I don't see making it through the weekend unless approval from Dr. for increase in dosage which will not happen because he is out of town and noone is there taking calls and he is not affiliated with any hospitals. The weekend will be rough and if lucky maybe Monday there will be a trip to the hospital but they will want to admit to geriatric psych unit which will want to remove all meds and start fresh with depakote and effexor. I also believe the Dr. is trying to wean someone who has taken benzo's and opiods for 20+ years too soon and I am not sure at 68 if it is such a good idea for full removal. Over the course of the last 2 months the same thing keeps happening and 1mg per day seems to be the correct dosage I feel that the Dr. pulling too much to soon but he will not listen. Over the course of 3 years the dosage has tapered at one point a dr. not this dr. had the dosage at 8mg. I believe the dosage was 4mg and since December has tapered to 1mg so there is improvement but this 1mg to .5mg in a 7 day period is not working like I said this is the 4th time it's been tried and the same reaction. Other meds are involved but I know the xanax is the main issue.