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.

I can say after reading through all of these comments that it is clear that we are definitely not all wired the same. Some of these I have not been prescribed. The Gabapentin at 1200 mg./day I had all of the rare, but serious side effects. I had no trouble going off of this medication. I have been on benzos in the past for anxiety and decided on my own to taper off. As for pain relief the only thing that has helped is Hydrocodone without the dreadful side effects. Due to all the restrictions now on opiates I hesitate to ask the pain specialist, but may do so as nothing else has helped. Gets very confusing and I have had so many negative reactions to tramadol, trazadone, effexor and numerous other synthetic medications I have up to now tried to to tough things out. I am one who has the rare and severe side effects to medications that help others. Can say I am becoming discouraged with pain that keeps me from doing some of the things I enjoy. Plan to speak with the pain specialist as the stalwart part of me is becoming most discouraged.
I know many of us are living with pain, anxiety, depression that robs us of quality of life.

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I started taking Klonopin in January of 2006, at 1mg, for anxiety disorder. I was taking 450mg of Wellbutrin already. This was before peripheral neuropathy entered my life.

The first few years with neuropathy I didn't need any medication, but around three years ago, I began experiencing increasing pain in my feet. I tried every medication for neuropathy, and then the neurologist recommended seeing a pain specialist. He took me through a bunch of meds that are off label for neuropathy, but are known to help some people. Nothing was helping. In the meantime, my pcp had me start taking morphine sulfate contin, and over the course of a year or so, I gradually worked up to 30mg tid. I finally found relief from the pain.

Last year I had a spinal cord stimulator implant in June and it reduced my pain by 80%. After that, I weaned off the morphine, to figure out if it was the morphine or Cymbalta that was helping my residual pain. After being off the morphine for 2-3 weeks, I knew that it was the medication I needed. I later weaned off the Cymbalta and didn't observe any effect, positive or negative, on the neuropathy pain. When I restarted morphine, I was able to get relief at 15mg bid.

Over the past couple of months, I've been having increased pain, and the stimulator is adjusted to its strongest setting, so I plan to ask my doctor to increase the morphine, beginning with adding a third pill at lunch. That's still a relatively low dose.

Back to the Klonopin, I tried several years ago to wean off it and went from 1mg to .75mg. After a few sleepless nights, I gave up. One of my doctors recommended that I continue taking it because it keeps me from acting out my dreams, specifically leg motion – read that, kicking my wife. She doesn't want me to stop taking the Klonopin. But, as I said, it's only 1mg.

My takeaway from the opioid/benzodiazepine discussion is that I will continue taking them because morphine is my last resort. I've run out of options. I think that my BIPAP will lower the risk of stopping breathing.

Jim

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@gailb

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.

Gail B
Volunteer Mentor

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Cool Gail enjoy

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@jimhd

I started taking Klonopin in January of 2006, at 1mg, for anxiety disorder. I was taking 450mg of Wellbutrin already. This was before peripheral neuropathy entered my life.

The first few years with neuropathy I didn't need any medication, but around three years ago, I began experiencing increasing pain in my feet. I tried every medication for neuropathy, and then the neurologist recommended seeing a pain specialist. He took me through a bunch of meds that are off label for neuropathy, but are known to help some people. Nothing was helping. In the meantime, my pcp had me start taking morphine sulfate contin, and over the course of a year or so, I gradually worked up to 30mg tid. I finally found relief from the pain.

Last year I had a spinal cord stimulator implant in June and it reduced my pain by 80%. After that, I weaned off the morphine, to figure out if it was the morphine or Cymbalta that was helping my residual pain. After being off the morphine for 2-3 weeks, I knew that it was the medication I needed. I later weaned off the Cymbalta and didn't observe any effect, positive or negative, on the neuropathy pain. When I restarted morphine, I was able to get relief at 15mg bid.

Over the past couple of months, I've been having increased pain, and the stimulator is adjusted to its strongest setting, so I plan to ask my doctor to increase the morphine, beginning with adding a third pill at lunch. That's still a relatively low dose.

Back to the Klonopin, I tried several years ago to wean off it and went from 1mg to .75mg. After a few sleepless nights, I gave up. One of my doctors recommended that I continue taking it because it keeps me from acting out my dreams, specifically leg motion – read that, kicking my wife. She doesn't want me to stop taking the Klonopin. But, as I said, it's only 1mg.

My takeaway from the opioid/benzodiazepine discussion is that I will continue taking them because morphine is my last resort. I've run out of options. I think that my BIPAP will lower the risk of stopping breathing.

Jim

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I agree with @ parus in regards to everyone being different and that is what I hate about the FDA and DEA making blanket pronouncements. They serve to scare physicians into not doing what is in their patient's best interests. When I was a financial advisor, the first SEC rule was "know your client". I assume physicians (good ones) do the same and should know exactly what will work for them even if developed through trial and error. I think the idea of a specialist for everything limits this relationship and wish there was a medical degree for a "one stop shop" or at least offices designed for one of each and group reviews, which is how I believe the best practices medical facilities handle treatment. Anyone ever had the genetic profiling done by either a MD or Psych.? Eventually, I think this will be almost as common as routine blood work to at least point toward the medication(s) that will serve each one the best.

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I've been interested in the genetic testing for medications for myself as I have bad reactions to lots of medications. Posted below is a link to the Mayo Education site that explains the simple process for having Genetic Testing for Medicines. You can even find out from Mayo what the costs would be. Of course the costs will differ for each place doing the tests. It sounds as if many of us have been guinea pigs long enough.

I know there are tests for antidepressants, but I don't know if there are tests for pain medications or other meds. You can ask you PCP to test you and find out what medications they can test for. It sure beats going through taking multiple meds and paying for them when they don't work for you. Im going to talk with my doctor about having this test for my antidepressant. Be sure to read the documentation as it contains information about insurance, etc. I hope this is helpful.

Gail B
Volunteer Mentor
http://mayoresearch.mayo.edu/center-for-individualized-medicine/drug-gene-testing.asp

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These comments and this forum is very helpful, hopefully optimistic.

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Well, isn't that wonderful for me. I'm 72 with insurable pain disease. What am I supposed to do?

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@jimhd

I started taking Klonopin in January of 2006, at 1mg, for anxiety disorder. I was taking 450mg of Wellbutrin already. This was before peripheral neuropathy entered my life.

The first few years with neuropathy I didn't need any medication, but around three years ago, I began experiencing increasing pain in my feet. I tried every medication for neuropathy, and then the neurologist recommended seeing a pain specialist. He took me through a bunch of meds that are off label for neuropathy, but are known to help some people. Nothing was helping. In the meantime, my pcp had me start taking morphine sulfate contin, and over the course of a year or so, I gradually worked up to 30mg tid. I finally found relief from the pain.

Last year I had a spinal cord stimulator implant in June and it reduced my pain by 80%. After that, I weaned off the morphine, to figure out if it was the morphine or Cymbalta that was helping my residual pain. After being off the morphine for 2-3 weeks, I knew that it was the medication I needed. I later weaned off the Cymbalta and didn't observe any effect, positive or negative, on the neuropathy pain. When I restarted morphine, I was able to get relief at 15mg bid.

Over the past couple of months, I've been having increased pain, and the stimulator is adjusted to its strongest setting, so I plan to ask my doctor to increase the morphine, beginning with adding a third pill at lunch. That's still a relatively low dose.

Back to the Klonopin, I tried several years ago to wean off it and went from 1mg to .75mg. After a few sleepless nights, I gave up. One of my doctors recommended that I continue taking it because it keeps me from acting out my dreams, specifically leg motion – read that, kicking my wife. She doesn't want me to stop taking the Klonopin. But, as I said, it's only 1mg.

My takeaway from the opioid/benzodiazepine discussion is that I will continue taking them because morphine is my last resort. I've run out of options. I think that my BIPAP will lower the risk of stopping breathing.

Jim

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At m point of pain, don't care about stopping breathing. At least my pain will stop and I won't be paralyzed.

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@galady

Well, isn't that wonderful for me. I'm 72 with insurable pain disease. What am I supposed to do?

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As I understand it, the FDA advice is a warning, not a requirement or prohibition. Does that mean patients using the double-barrel medications can work out a response with their doctor? And if not, get a second opinion from another doctor? I think so. Will that work for you @galady ?

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@jimhd

I started taking Klonopin in January of 2006, at 1mg, for anxiety disorder. I was taking 450mg of Wellbutrin already. This was before peripheral neuropathy entered my life.

The first few years with neuropathy I didn't need any medication, but around three years ago, I began experiencing increasing pain in my feet. I tried every medication for neuropathy, and then the neurologist recommended seeing a pain specialist. He took me through a bunch of meds that are off label for neuropathy, but are known to help some people. Nothing was helping. In the meantime, my pcp had me start taking morphine sulfate contin, and over the course of a year or so, I gradually worked up to 30mg tid. I finally found relief from the pain.

Last year I had a spinal cord stimulator implant in June and it reduced my pain by 80%. After that, I weaned off the morphine, to figure out if it was the morphine or Cymbalta that was helping my residual pain. After being off the morphine for 2-3 weeks, I knew that it was the medication I needed. I later weaned off the Cymbalta and didn't observe any effect, positive or negative, on the neuropathy pain. When I restarted morphine, I was able to get relief at 15mg bid.

Over the past couple of months, I've been having increased pain, and the stimulator is adjusted to its strongest setting, so I plan to ask my doctor to increase the morphine, beginning with adding a third pill at lunch. That's still a relatively low dose.

Back to the Klonopin, I tried several years ago to wean off it and went from 1mg to .75mg. After a few sleepless nights, I gave up. One of my doctors recommended that I continue taking it because it keeps me from acting out my dreams, specifically leg motion – read that, kicking my wife. She doesn't want me to stop taking the Klonopin. But, as I said, it's only 1mg.

My takeaway from the opioid/benzodiazepine discussion is that I will continue taking them because morphine is my last resort. I've run out of options. I think that my BIPAP will lower the risk of stopping breathing.

Jim

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@galady, I have been in exactly the same place in terms of not feeling like I was taking a huge risk with the shape I was in. I am sorry that you are not getting relief and wish the best for you and your situation.

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@jimhd

I started taking Klonopin in January of 2006, at 1mg, for anxiety disorder. I was taking 450mg of Wellbutrin already. This was before peripheral neuropathy entered my life.

The first few years with neuropathy I didn't need any medication, but around three years ago, I began experiencing increasing pain in my feet. I tried every medication for neuropathy, and then the neurologist recommended seeing a pain specialist. He took me through a bunch of meds that are off label for neuropathy, but are known to help some people. Nothing was helping. In the meantime, my pcp had me start taking morphine sulfate contin, and over the course of a year or so, I gradually worked up to 30mg tid. I finally found relief from the pain.

Last year I had a spinal cord stimulator implant in June and it reduced my pain by 80%. After that, I weaned off the morphine, to figure out if it was the morphine or Cymbalta that was helping my residual pain. After being off the morphine for 2-3 weeks, I knew that it was the medication I needed. I later weaned off the Cymbalta and didn't observe any effect, positive or negative, on the neuropathy pain. When I restarted morphine, I was able to get relief at 15mg bid.

Over the past couple of months, I've been having increased pain, and the stimulator is adjusted to its strongest setting, so I plan to ask my doctor to increase the morphine, beginning with adding a third pill at lunch. That's still a relatively low dose.

Back to the Klonopin, I tried several years ago to wean off it and went from 1mg to .75mg. After a few sleepless nights, I gave up. One of my doctors recommended that I continue taking it because it keeps me from acting out my dreams, specifically leg motion – read that, kicking my wife. She doesn't want me to stop taking the Klonopin. But, as I said, it's only 1mg.

My takeaway from the opioid/benzodiazepine discussion is that I will continue taking them because morphine is my last resort. I've run out of options. I think that my BIPAP will lower the risk of stopping breathing.

Jim

Jump to this post

My mom is in the same type of pain, and tells me regularly she is at the point she just doesn't care anymore. If it wasn't for the care of my father I truly believe she would give up and had rather be with our heavenly father than here on earth in the pain she has to withstand daily. I pray for those who are in this type of agony and hope each day something or someone can find a medication or procedure to help those suffering. I am looking for answers as you are and there does not seem to be any easy or good ones…

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@galady

Well, isn't that wonderful for me. I'm 72 with insurable pain disease. What am I supposed to do?

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@predictable

It may be a warning and not a requirement, but doctors and clinics, including the one I go to, are cutting way back on the maximum dosage doctors are allowed to prescribe. My pcp told me that if I need more than 100mg of my meds combined, I would have to have a clearance from my pain specialist because of the new restrictions placed on him.

Jim

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