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Dangerous drug combinations an issue for comp, U.S. in general

Posted On: Feb. 25, 2016 12:00 AM CST

Dangerous drug combinations an issue for comp, U.S. in general

The workers compensation industry's focus on combating overuse of opioids overshadows risks associated with powerful psychoactive drugs and taking multiple drugs simultaneously.

Benzodiazepines, or tranquilizers such as Xanax and Valium, were involved in about 31% of the estimated 22,767 U.S. drug overdose deaths in 2013, according to a study published last week by the American Journal of Public Health.

“Opioids are kind of the sexy drug that everybody understands, but benzos are just as bad for some of the same reasons,” said Mark Pew, senior vice president at Duluth, Georgia-based medical management company Prium. “There's a growing acknowledgment of that.”

While the study doesn't touch on how benzodiazepines have affected workers comp, it does say interventions are needed in general to decrease the use of such drugs, which have sedative, hypnotic, anti-anxiety, anticonvulsant and muscle relaxant properties.

As more steps are taken to limit the use of opioids, some patients may experience “greater stress, anxiety and difficulty with sleeping,” Dr. Joel E. Mata, medical director at third-party administrator and managed care services provider CorVel Corp. in San Diego, said in an email.

With the media fixated on “risks associated with opioid-based drugs, patients may inadvertently not recognize the potential hazards of … long-term benzodiazepine use, such as dependence, paradoxical anxiety and seizures with abrupt withdrawal,” Dr. Mata said.

The number of adults filling a benzodiazepine prescription increased 67% from 1996 to 13.5 million in 2013, the study found. Among those filling such prescriptions, “the median quantity filled … more than doubled between 1996 and 2013, suggesting either a higher daily dose or more days of treatment,” according to the study.

However, the long-term use of benzodiazepines to treat injured workers has decreased, according to the most recent drug trend report by pharmacy benefit manager Helios.

Though many occupational health guidelines say not to prescribe opioids with benzodiazepines, sleeping pills or muscle relaxants, sources say dangerous drug combinations are still prescribed for some injured workers.

“You definitely should not be using benzos with opioids,” said Dr. Gary Franklin, medical director of the Washington State Department of Labor and Industries, the state's monopoly workers comp insurer. “They're both overused, and the danger of both together is way worse than the danger of opioids alone.”

For example, mixing a Xanax with an opioid creates a “heroin-type euphoria,” Mr. Pew said. “If you see any kind of benzo with an opioid, or benzo with soma, which is a muscle relaxant, it has absolutely nothing to do with pain management. It has everything to do with getting high.”

Since benzodiazepines are addictive and “very combustible with alcohol,” they're the last drug class from which injured workers are weaned, Mr. Pew said.

“It can take up to 18 months to wean somebody organically off of a benzo,” he said.

Sources agree one way to limit the use of benzodiazepines in workers comp is to utilize evidence-based nonpharmacological treatments, such as cognitive behavioral therapy.

“Patients may not be aware of the many different nonprescription-based treatments available to them to treat conditions, such as stress, anxiety and difficulty with sleeping,” Dr. Mata said. “Increased exercise, improved sleep hygiene, aroma therapy and acupuncture are a few of the many different approaches that have been found to be effective.”