Women, Opioids, Benzodiazepines and Pain: A Potential Deadly Combination

 

When we think of the segments of the population who have been most affected by the opioid epidemic, we tend to think of poor, unemployed people who live in rural areas. In September of 2016, I published a blog called “Tough Times Feed America’s Opioid Epidemic: What You Need To Know.” In it, I described how the disease of addiction and overdoses can infest an economically-challenged community. I referenced a CNN article written by Wayne Drash and Max Blau, “In America’s drug death capital: How heroin is scarring the next generation,” that tells the story of how addiction, poverty, and social issues together have opened the door to increased opioid use and deaths in America’s heartland. Additionally, I mentioned a book titled Dreamland: The True Tale of America’s Opiate Epidemic, in which author Sam Quinones ties the opioid epidemic to the same risk factors: poverty, hopelessness, and unemployment.

Substance Abuse Disorder Cuts Across All Demographics

However, I want to be clear: the problem of substance abuse disorder cuts across all demographics. If you think you won’t become a statistic because you’re not on the lower part of the socio-economic scale, a recent Washington Post article will serve as a wake up call. The article, “Risky alone, deadly together,” written by Kimberly Kindy and Dan Keating, relays the fact that white, middle-aged women — a subset of the population we tend to think of as relatively privileged — are also increasingly becoming casualties of the opioid epidemic.

According to the Washington Post article, the combination of opioids, benzodiazepines, and alcohol can lead to overdose deaths or deaths by suicide. Middle-aged women, in particular, are at risk. One reason for that, according to the article, is the fact that middle-aged women are often prescribed opioids and benzodiazepines, which are anti-anxiety drugs, in tandem. The Washington Post says, “White women are more likely than women of other races to be prescribed opiates, and far more likely to be prescribed both opiates and anti-anxiety drugs, according to a Post analysis of middle-aged participants in the latest National Health and Nutrition Examination Survey. White women prescribed opiates are five times as likely as white men to be given that drug combination — helping to explain why white women may be at special risk.”

The Deadly Combination of Opioids, Benzodiazepines, and Alcohol 

“That drug combination” was singled out as problematic in an August 31, 2016 press release the FDA issued with the headline, ”FDA requires strong warnings for opioid analgesics, prescription opioid cough products, and benzodiazepine labeling related to serious risks and death from combined use.” It reads, in part, “After an extensive review of the latest scientific evidence, the U.S. Food and Drug Administration announced today that it is requiring class-wide changes to drug labeling, including patient information, to help inform health care providers and patients of the serious risks associated with the combined use of certain opioid medications and a class of central nervous system (CNS) depressant drugs called benzodiazepines.”

In 2008, I published a paper titled “Sleep-Disordered Breathing and Chronic Opioid Therapy.” In it, I reported a strong relation between respiratory depression and daily dosages of opioids and benzodiazepines. This was one of the earliest reports suggesting the danger of combining opioids with benzodiazepines in people with chronic pain. Despite the publication of this report, it has taken nearly a decade for the problem to receive broad recognition within the FDA and the medical community.

That time lag may have led to suffering, and death, for many people, including middle-aged women. As women age, they may begin to suffer from such painful conditions as back pain, lupus, and arthritis, and they may find opioids the only way to manage their pain. They may also use alcohol to self medicate. Menopause, with the hormonal imbalance that accompanies it, has often been treated with anti-anxiety drugs including benzodiazepines.

Untreated Pain Can Also Lead to Death

However, what the Washington Post article doesn’t mention is that untreated pain, too, leads to suicides. In fact, the number of suicides is nearly double the number of deaths associated with opioids. There is increasing concern that a significant number of the suicides are a result of inadequately treated pain. The CDC Opioid Prescribing Guideline, unfortunately, has made it increasingly difficult for people in pain to receive the treatment they need. The result may be a greater number of deaths from suicide — not only of white middle-aged women, but of people from every demographic group.

The Washington Post is correct to point out that white middle-aged women who have felt they are not at risk of falling victim to the harm from opioids need to rethink that. They are as vulnerable as everyone else. As I said in another recent blog, “The Painful Truth About Suicide,” suicide can happen to any of us. Suicide is an equal opportunity choice that can affect anyone, from any walk of life. It doesn’t matter whether you’re poor or wealthy, famous or unknown, or male or female. Suicide often is the result of physical and emotional trauma, and pain medication (sometimes, in combination with benzodiazepines and/or alcohol) can be the means of self-harm.

Anxiety, depression, and other mental health disorders are not the sole domain of the disenfranchised, poverty-stricken segments of our population.