Are Benzos the New Opioids? COVID-19 may be contributing to a troubling new trend.

The COVID-19 pandemic is the most stressful time in nearly seven out of 10 employees’ professional careers. Every demographic rated the pandemic more stressful than the September 11 terrorist attacks, the 2008 economic recession and other events.

This unyielding stress has prompted a 34% increase in anti-anxiety medications, such as benzodiazepines, from mid-February 2020 to mid-March 2020, according to an analysis from Express Scripts, a subsidiary of health insurer Cigna. The increase in anti-anxiety prescriptions due to pandemic stress could exacerbate another trend associated with benzodiazepines, also known as ‘benzos,’ which have increasingly been prescribed to help manage pain.

Growth of benzodiazepines

Although opioid prescriptions in 2018 had fallen to the lowest level in 13 years, the number of benzodiazepine prescriptions, that includes the brand name drugs Valium and Xanax, have increased. A major driver in the growth of anti-anxiety prescriptions appears to be primary care physicians, which accounted for half of all benzodiazepine visits. Studies show that benzodiazepine prescriptions for chronic pain grew from 3.5% of visits to 8.5% while the prescribing rate of benzodiazepines with opioids quadrupled from 0.5% to 2.0% of visits.

Benzos, like their opioid counterparts, are highly addictive with physical dependence emerging in less than a month. However, because they are not an opioid, patients are not receiving the screening and education about those health risks, particularly when the drugs are mixed with alcohol or opioids, which can lead to accidental overdose deaths.

While prescribed most often for anxiety, as we are seeing now with COVID-19, 22% of Americans responding to a 2018 Gallup Poll on back and neck pain reported they took benzodiazepines for their pain at the same rate as opioids. Worse yet, the two drugs are often prescribed or taken together, which increases risks to the patient’s health. A study published in 2019 in the journal Sleep found that the concurrent usage of both drugs increased by 250% over 15 years, while there was an 840% increase in that time of patients taking different types of benzodiazepines.

Dangers prevalent

Unlike opioids, death from benzodiazepine misuse alone is rare. More commonly, fatal overdoses are the result of mixing the medication with alcohol and/or other drugs. Several well-known celebrity deaths, including rock musician Tom Petty and actor Philip Seymour Hoffman, were attributed to opiates mixed with benzos.

For employers, benzodiazepine use by their employees carry numerous other risks, the least of which is absenteeism and decreased productivity, but also falls and motor vehicle crashes when employees are on the clock, leading to injury and liability issues. Combined with opioid use, performance, error and injury risks increase.

 Do risks outweigh the benefits?

“Benzodiazepines have proven utility when they are used intermittently and for less than one month at a time,” wrote the authors of a New England Journal of Medicine article on the topic in 2018. “But when they are used daily and for extended periods, the benefits of benzodiazepines diminish and the risks associated with their use increase.”

Better yet, could we consider less risky options for patients before prescribing an opioid or a benzodiazepine? Non-pharmacological care for pain has proven both safe and effective. In fact, in April 2019, the World Health Organization published an article that reviewed six sets of updated international guidelines for managing low back pain, pointing out that all recommend avoiding medication, if possible, as a first step. They also highlight that after educating patients about low back pain and urging them to remain active, the second-step care options generally include: therapies such as spinal manipulation, most often performed by a doctor of chiropractic (DC), as well as massage and exercise. Chiropractic is a 125-year-old evidence-based modality often used to relieve neuro-musculoskeletal pain and concurrently has been shown to improve structural stress. Spinal manipulation, for example, most often performed by doctors of chiropractic (DCs), triggers an increase in the hormones neurotensin and oxytocin, which have calming and pain relief effects.

More than 90% of chronic back and neck pain sufferers are highly satisfied with chiropractic care, according to the results of a nationwide survey published in 2018. In turn, chiropractic demonstrates an inverse association between chiropractic use and opioid receipt among patients with spinal pain and may have similar outcomes for benzodiazepines that are a replacement or taken at the same time as the painkillers.

By choosing health benefits that promote chiropractic care through lower co-pays and fewer visit restrictions, employers can help encourage their employees to seek such care and reverse the trend of benzodiazepine overprescribing. During this stressful time, employers can help their employees access drug-free care that helps reduce their stress and improve their overall quality-of-life for higher productivity and morale.