Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression

Even those with no previous medical history of mental health issues have experienced the emotional, financial, social, occupational and interpersonal impact that the coronavirus pandemic has brought worldwide. Due to the way in which these drugs can affect the brain, there is a tendency for a tolerance to develop. This basically means that you might find that you are not achieving the same level of relief from your medication that you did when you first started to take it as your brain and body has adapted to its presence. This risk is rapidly increasing as more people are using these drugs alongside other psycho-active drugs and overdosing.

Slight reductions in systemic vascular resistance, preload, cardiac output and blood pressure may be occasionally observed, but are well tolerated in healthy patients1. 23.0% of drug poisoning deaths registered in 2020 had no drug type recorded on the coroner’s death certificate (for example, records only mention “drug overdose” or “multiple drug toxicity”). In 2020, the highest rate of drug misuse deaths was observed in the North East (104.6 deaths per million; 258 registered deaths), while the lowest rate was in London (33.1 deaths per million; 296 deaths). The North East has had the highest rate of drug misuse for the past eight years and has a statistically significantly higher rate than all other regions of England. Age-adjusted drug overdose death rates by opioid category, United States 1999–2016 . A Massachusetts study determined that 96% of this fentanyl was illicitly manufactured .

• Going through the ordeal of benzodiazepines addiction can be really difficult and daunting.
• Flumazenil is rapidly acting, demonstrating clinical effects within 2 minutes of administration2, although the duration of action is shorter than either diazepam or midazolam.
• Whilst the deceased did not have the protection of the Data Protection Act, the advice was that the process of this information should still enshrine a duty of confidentiality, so all the normal data security safeguards were put in place.
• In this article Carl Bradbrook discusses the peri-ananesthetic management of the canine gastric dilatation and volvulus patient.
• Northern Ireland’s most recent official statistics on drug-related deaths in 2019 and earlier years, broken down by cause of death, selected drugs reported, age and sex.

Stopping them suddenly can result in severe and life-threatening withdrawal symptoms. CATCH Recovery, is a private outpatient therapy centre, providing high quality treatment for alcohol and drug addiction and related mental health problems. Although benzodiazepines are prescribed for the treatment of conditions such as panic disorder, anxiety, and insomnia, it is recommended by most medical professionals that they are prescribed for short-term use only due to the high potential for abuse.

In this article, Carl focuses on the benefits of introducing a safety checklist in practice to reduce patient morbidity, mortality and to improve communication between members of the veterinary team. The article contains links to the AVA safety checklist as well as a link to a customisable list that you can adapt to your practice needs. This recent paper compares post-operative pain scores and requirement for rescue analgesia following premedication with methadone or buprenorphine, in combination with acepromazine or medetomidine, in 80 bitches undergoing ovariohysterectomy. This recent study examined whether the application of EMLA cream, for 30 or 60 minutes, would be a useful tool to improve patient compliance prior to intravenous cannula placement in the veterinary clinical practice setting.

Paper summary: Intramuscular butorphanol/alfaxalone combination for sedation of cats prior to echocardiography

These results are congruent with those of multiple studies of management of post-surgical pain in opioid-naïve patients, which have revealed an ~15-fold variability in opioid dose requirements (28–31). This experience with opioid-naïve patients suggests that dose-variability is a phenotypic phenomenon and not simply related to tolerance. Professional treatment starts with a medically-assisted detox programme that will aid your body to flush out the remnants of the benzodiazepines in your system. Doctors will also employ medication therapies, as well as psychotherapy, to help manage your withdrawal symptoms and make them more bearable. Going through the ordeal of benzodiazepines addiction can be really difficult and daunting. You, or your loved one, may have the desire to quit, but be unable to manage the withdrawal symptoms that flare up whenever you stay away from the drug.

The first of the CDC’s 12 recommendations for treatment of chronic non-cancer pain was “Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred” . This statement implies that there is evidence that non-pharmacologic therapies are beneficial for chronic non-cancer pain, and the balance of benefit and risk for these therapies is superior to that achieved with opioids. The benefits and risks of opioid therapy were reviewed above and the risk of harm with non-pharmacologic therapies is likely to be low. Therefore, we will focus on the issue of effectiveness of non-pharmacologic therapies.

If you’re hooked on any of these drugs, it’s important to find out more about your addiction so that you know what you’re dealing with and the right steps to take. There are free confidential addiction helplines in the UK that can also get you further help. Healthcare professionals are asked to report any suspected adverse drug reactions to drugs to the Yellow Card scheme.

A stepwise multiple regression model with a “backward” procedure was computed for each CVD pathology and for the total CVD severity score. This identified which drug classes and demographic variables best predicted CVD severity. Specifically, all drug classes and all demographic characteristics were included simultaneously in the first step of each regression model as independent variables . A request for research access to clinical data relating to the deceased must be treated in the same way as one for data relating to the living. The proposal was considered by NHS Fife Research and Development Department, South-East Scotland Regional Ethics Department and NHS Fife Caldicott Guardian on its own merits as per any other project.

Benzodiazepine use can negatively affect your mental health and may increase the risk of suicidal thoughts particularly in young adults and those who are alcohol or opioid dependent. Addiction to a benzodiazepines occurs when you take one of these medications for longer or more than is recommended by a physician. Benzodiazepines are known to be addictive drugs that are often taken for the pleasurable effects they induce. Even through a legitimate prescription, it’s easy to become addicted to these types of drugs. You may be abusing benzos even if they are prescribed by a doctor; this is called “doctor shopping” and means that patients often visit more than one medical specialist in order to receive multiple prescriptions for the same medication. Benzos are addictive due to the way they interact with the brain and how they hijack neurochemical processes.

Comparing with other statistics

Overdose can also occur when taken in combination with alcohol or other harmful substances. There are many risks involved in overdosing on benzodiazepines and they include dangerously slowed breathing, coma, extreme dizziness, blurred vision, and slurred speech, among others. Abuse of benzodiazepines occurs when you consume excess amounts or continue using even after your prescription period has expired.

In this article Carl Bradbrook discusses the peri-ananesthetic management of the canine gastric dilatation and volvulus patient. This paper by Pottie et al examines the effects of hypothermia on recovery from general anaesthesia in the dog. Laryngeal oedema is a potentially life-threatening complication of invasive BOAS surgery. In this case study by Ellis and Leece the use of nebulised adrenaline to successfully manage this condition is described. Petruccione et al. compares the effect of using either dexmedetomidine or acepromazine, when both are combined with methadone, for the pre-anaesthetic medication of dogs undergoing brachycephalic obstructive airway syndrome surgery. The induction agent should be administered immediately following the BDZ as, if too much time is allowed to elapse, excitement may occur.

• This study examined the effects of alfaxalone versus propofol induction of the dam on the Apgar scores of delivered puppies.
• Because the people caught up in the crisis live substantially off the medical grid until they die, it is difficult to know exactly who they are.
• In healthy patients disinhibition, or paradoxical excitement, is commonly observed rather than anxiolysis/sedation3,8, and previously calm animals can become aggressive5,6.
• Both midazolam and diazepam undergo initial oxidation followed by conjugation via the cytochrome P450 system in the liver1.
• This study by Okushima et al examined the effects of alfaxalone versus propofol on heart rate at the time of induction of anaesthesia.

You’ll undergo a detox programme that will clear the drug’s toxins from your system and go on to receive psychological treatment through rehabilitation. You should seek help the moment you realise that your use of a benzodiazepines is slipping out of your control. It can be hard to find out that a loved one is abusing or has become addicted to a benzodiazepines. You should take note to look out for warning signs https://sober-home.org/ of abuse and addiction and report to your doctor before things slip out of control into a full-blown addiction. Some of the warning signs may come a few days to weeks after your loved one goes beyond their prescription, depending on how much you consume. While most people take the drugs without the intention to abuse them or to get high, some use benzos recreationally, following a straight path to addiction.

However, high doses of benzodiazepines can produce very serious side effects. Benzodiazepines are sedative-hypnotics also known as depressants or sedatives and are commonly prescribed medication. These drugs come in many different forms but, in essence, their main effects are the same, and work by slowing down your brain activity. This makes it useful in helping those who struggle physically, for example, people who suffer from convulsions, as well as anyone suffering from mental disabilities such as severe anxiety. This is our third product launch this year, and the latest addition to our anaesthesia and analgesia portfolio, Methadyne, contains 10mg/ml methadone as its active ingredient.

Some of the drugs known to be combined by users include opioids like morphine and heroin; suboxone; and alcohol. Using any of these substances alongside benzodiazepines is extremely dangerous and is never advised. Benzodiazepines are mostly abused by patients who are being treated with the medication for medical conditions.

The Relationship of Depression to Chronic Pain and Its Treatment

Little information is available about the effect that different doses of medetomidine and butorphanol may have when using sevoflurane for maintenance of anaesthesia in dogs. This recent study evaluates heart rate and median sevoflurane concentration required at different dose rates. In this summary of a paper by Valverde we examine the effects of high-volume, rapid fluid therapy on cardiovascular function and hematological values during isoflurane-induced hypotension in healthy dogs. In this summary eco sober house review of an article by Acierna et al we compare a veterinary specific oscillometric device to direct blood pressure measurement. Improving efficiency and “saving time” are key to increasing throughput in busy clinical practice, especially when the normal working environment has been disrupted, where there is an increased demand for services, or when surgical lists become overloaded. This article provides potential solutions for some common bottlenecks and inefficiencies during the anaesthetic process.

Millions of people around the world are leaving their doctor’s office with a prescription in hand. Combining heroin and opiates with alcohol is dangerous as both substances slow down the respiratory system and the brain and could cause them to fail. Perspectives on Premeds is a series of articles touching on different pharmacological, physiological and clinical aspects of pre-anaesthetic medication.

They were 3–4 times as likely as non-opioid users to report alcohol dependence or abuse (19.2, 25.6, 16.2%). They were far more likely to use other drugs, including sedatives, tranquilizers, stimulants, hallucinogens, inhalants, methamphetamine, cocaine, or marijuana (68, 82.7, and 92.9% reported use of one or more). This post-mortem study revealed a significant positive association between opioids identified in the blood of post-mortem cases and severity of CVD pathologies. Findings from the current study have thepotential to inform national clinical guidelines on the need to monitor individuals who abuse opioids for signs of CVD and provide timely interventions. In fact, the early identification of high risk/at-risk opioid users would contribute to the reduction of early morbidity/mortality in this population.

A retrospective comparison of two analgesic strategies after uncomplicated tibial plateau levelling osteotomy in dogs.

The sample consisted of 78,976 respondents aged 12 years or older living in households or non-institutional group housing who were representative of non-elderly US adults in 2015–2016. Data on sensitive questions were obtained through a computer driven audio interview arranged to assure anonymity. Weighted estimates suggested that 91.8 million (37.8%) of U.S. civilian non-institutionalized adults used prescription opioids over the prior year. Of these, 12.5% reported opioid misuse and 2.1% opioid abuse (defined as meeting ≥1 of four DSM-4 abuse criteria).

Premedication with an opioid administered intramuscularly and allow a suitable period of time to reach peak effect. BDZ, in combination with an opioid, are suitable for premedication of debilitated patients in the ASA III and above category or for paediatric/geriatric animals5,6,11. Diazepam has a slower onset of action than midazolam and a longer duration of action (4-12 hours for diazepam compared to 1-4 hours for midazolam)6. The plasma elimination half-life of diazepam is 3.2 hours in the dog3, with an even longer half-life for the active metabolite desmethyldiazepam3,4. Intravenous administration of the lipid emulsion formulation of diazepam is non-irritant and less painful than the aqueous product, therefore, in the majority of patients the emulsion is the preferred product5.

They also support people who are thinking about taking them or are trying withdraw from them. You can talk to your doctor or local pharmacist if you are worried about the withdrawal effects of benzodiazepines. You may not get withdrawal side effects when you stop your benzodiazepine medication. This is because your body will be used to the medication, and you might experience withdrawal symptoms.

Preoxygenation Study Highlights

Two-thirds of registered drug poisoning deaths in 2020 were related to drug misuse, accounting for 52.3 deaths per million people. The age patterns of opioid use cited above suggest that young people are particularly likely to respond to these factors with opioid abuse. From an analytic point of view, these factors contribute to unexplained statistical variance.