Researchers recently discovered that the proportion of overdose fatalities involving non-benzo sleeping/z-drugs and anti-epilepsy gabapentinoids increased over three-fold from 2000 to 2018, concurring with the exponential prescription rise since they were introduced into the market.
A EurekAlert report said with an alarming increase in the number of prescriptions for these drugs over the last 20 years, Columbia University Mailman School of Public health researchers aimed to fill in the gap in knowledge in the fraction of overdose deaths that involve those medications and find out more about their co-usage with other substances throughout the United States demographics categories.
To date, there were small data on overdose deaths that involved non-benzodiazepines and gabapentinoids.
Specifically, more than 67 percent of people dying from overdoses using these drugs from 2000 to 2018 had opioids as well, in their system specifying that using more than a single substance is the norm.
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According to the Centers for Disease Control and Prevention, the US has seen an increase in drug overdose deaths during the Covid-19 pandemic, accelerating significantly during the first months of the public health emergency, including deaths from opioids and counterfeit pills containing fentanyl.
'Less Hazardous' Substitutes
According to Silvia Martins, MD, Ph.D., senior author of the study and epidemiology professor at Columbia Mailman School, these medication classes were introduced as less hazardous substitutes to benzodiazepines and opioids, developing perceptions among physicians and patients of their supposed heightened safety even minus the guidelines or data to support such perceptions and result in prescription increases.
Authorized for short-term insomnia therapy, these drugs were touted as a safe substitute to the commonly used benzodiazepines when introduced to the market as less susceptible to dependence or abuse.
Yet, recent evidence proposes that this substitute may be harmful, too, as the product is intended to replace parts. The lead author said it was crucial to explore further and particularly identify the dangers of these drugs' co-usage.
Overdose Code
Employing data from the National Center for Health Statistics, the study investigators computed the overdose death rate in every 100,000 individuals for each year between 2000 and 2018.
The study published in The Lancet Regional Health - Americas specified that during this period, more than 788,000 people died with an "overdose code" as the underlying reason for death.
Out of this number, about 587,884 individuals had any T or specific code for the medication involved among their multiple reasons for death.
More intentional overdoses were recorded, and a greater fraction of women, a greater portion of whites, as well as those who have higher educational backgrounds died from an overdose between 2000 and 2018 with a T code of "T42.6/T42.7 ICD compared to the population of general overdose casualties.
Role of Increased Prescription in Overdose Death
On top of being prescribed to prevent or replace opioids and benzodiazepines, gabapentinoids are frequently offered off-label for such circumstances as insomnia and anxiety.
Martins noted that the increase in prescriptions of gabapentin roughly accompanies z-drugs and gabapentinoids' involvement in overdose fatalities, suggesting they can be playing a role in such deaths.
The literature has presented rising deaths with gabapentin co-using with other substances, including alcohol. Prescription opioids and benzodiazepines are the most classes of medication involved in drug-related emergency room visits, as well as drug overdose deaths in the United States. When excessively taken, both prescription opioids and benzodiazepines stimulate respiratory decline.
Related information about the use of benzodiazepine is shown on BJGP's YouTube video below:
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