​While much attention has been paid to the opioid epidemic, Americans may be ignoring a looming crisis related to overprescribing of benzodiazepines, according to the authors of a February 22, 2018, perspective in the New England Journal of Medicine. Benzodiazepines, such as alprazolam, clonazepam, diazepam, and lorazepam, are prescribed for a diverse set of indications, including anxiety, insomnia, seizures, and acute alcohol withdrawal. The number of adults who filled a benzodiazepine prescription rose from 8.1 million in 1996 to 13.5 million in 2013; an increase of 67%. The quantity of benzodiazepines obtained tripled during that time, the authors said. Meanwhile, the authors said, the adverse effects of benzodiazepine misuse, overuse, and addiction have gone “largely unnoticed." Part of this may be because three-quarters of deaths involving benzodiazepines also involved opioids, the authors said. As is the case with the opioid crisis, highly-potent new forms of benzodiazepines are penetrating the illegal market, the authors said. These drugs are often indistinguishable from prescription benzodiazepines and could end up as deadly as the synthetic opioid analogue fentanyl, the authors said. Overprescribing of benzodiazepines may be fueling the rise of these illegal analogues, similar to the way opioid prescriptions fueled the rise of fentanyl. Benzodiazepines have proven utility when used intermittently and for less than one month at a time, the authors said. However, when used daily, their benefits diminish and risks increase. “It would be a tragedy if measures to target overprescribing and overuse of opioids diverted people from one class of life-threatening drugs to another," the authors said. “We believe that the growing infrastructure to address the opioid epidemic should be harnessed to respond to dangerous trends in benzodiazepine overuse, misuse, and addiction as well."

HRC Recommends: An essential component of medication safety is safe prescribing practices. The study authors call attention to the U.S. Food and Drug Administration's (FDA) black box warning regarding the dangers of coprescribing benzodiazepines and opioids and warn of the dangers of overprescribing benzodiazepines. HRC concurs with FDA's recommendation that prescribers be required or encouraged to check their state's prescription drug monitoring program (PDMP) before prescribing benzodiazepines—a step that is often required with opioids. PDMPs, available in every state, typically allow prescribers to see federally controlled and addictive medications prescribed to a particular patient within a given period (usually the past 12 months). Using PDMPs allows prescribers to check for dangerous drug combinations (such as combinations of opioids and benzodiazepines) and also determine whether the patient is "doctor shopping."