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Commentary: Next big drug problem lurks on the horizon

Benzodiazepine photo from Flickr.

Imagine it were possible to return to the time before opioid use soared in the U.S.—to the early 1990s, before so many doctors came to overprescribe Oxycontin, Vicodin and the like for every imaginable kind of pain; before millions became addicted; before prescription opioid users switched to heroin and deadly street fentanyl.

Back then, the crisis might have been nipped in the bud.

Today, the U.S. may stand at another such moment. Its next huge drug problem seems likely to be benzodiazepines. Better known as Xanax, Valium and Klonopin, they are tranquilizers used to treat anxiety and insomnia—maladies at least as universal and hard to measure and cure as pain. In this century, the number of adults filling benzodiazepine prescriptions has increased nearly 70 percent, and the quantities taken have tripled.

Though overdose deaths involving benzodiazepines are fewer than those from opioids—about 9,000 in 2015 (the most recent year of data) compared with more than 42,000 for opioids in 2016—the number is some eight times what it was in 1999.

What's more, a great many of those opioid victims were simultaneously taking benzodiazepines, which compound the opioids' power to slow breathing to a stop. Since 2001, the share of opioid users who also take benzodiazepines has doubled, leading the Food and Drug Administration to issue a strong warning against co-prescribing.

The death count tells just part of the story, leaving out the struggles of people who take benzodiazepines daily, on doctors' orders, for years and years, even though the drugs are ideally used for only a month or less at a time.

Like opioids, benzodiazepines are also purposely abused by some—to strengthen the kick of an opioid high or, on their own, to induce a stupor like drunkenness. There's even a highly potent black-market product that's manufactured, as street fentanyl is, in underground labs: clonazolam, a counterfeit Xanax-Klonopin combination. As with fentanyl, a tiny amount can cause overdose.

To stop this epidemic in its tracks will take the kind of concerted push that has so far been lacking against opioids. States need to strengthen their prescription databases, and see that doctors check them to avoid writing benzodiazepine prescriptions for people who either already have them or are taking opioids. Health insurers should move to monitor and discourage benzodiazepine overprescribing, as some have done for opioids. States and the federal government need to gather more recent and detailed data on the extent and severity of benzodiazepine dependence, and on the potency of the street versions. Police need to clamp down on the illicit trade. And doctors and patients alike need to be educated about the proper uses and the dangers of these drugs.

At the moment, Congress, the White House and the states are all considering stronger measures against opioids. That's overdue. On benzodiazepines, they should act now to avoid making the same mistake again—by including them in their current deliberations and taking steps to rein in this other epidemic before it gets any worse.