New labels warn against mixing opioids, benzodiazepines | CNN

Prescription and illegal opioids are commonly abused because they are so addictive. <br /><br />Opioid medications bind to the areas of the brain that control pain and emotions, driving up levels of the feel-good hormone dopamine in the brain's reward areas and producing an intense feeling of euphoria.<br /><br />As the brain becomes used to the feelings, it often takes more and more of the drug to produce the same levels of pain relief and well-being, leading to dependence and, later, addiction.

Prescription and illegal opioids are commonly abused because they are so addictive.

Opioid medications bind to the areas of the brain that control pain and emotions, driving up levels of the feel-good hormone dopamine in the brain's reward areas and producing an intense feeling of euphoria.

As the brain becomes used to the feelings, it often takes more and more of the drug to produce the same levels of pain relief and well-being, leading to dependence and, later, addiction.

Shutterstock

Oxymorphone hydrochloride —

Oxymorphone hydrochloride, under the name Opana ER, was at the center of an HIV outbreak in Indiana in 2015. Some addicts began injecting and shared needles increased the spread of HIV.

In June, the Food and Drug Administration requested that Opana ER manufacturer Endo Pharmaceuticals pull the drug from the market. It was the first time the agency has asked that a opioid pain medication be pulled "due to the public health consequences of abuse." Endo announced in July that it would pull the drug.

From Opana.com

Codeine —

Codeine is one of the weakest opioids, often given when painkillers such as acetaminophen or ibuprofen fail to work. Because it decreases activity in the part of the brain that controls coughing, it's frequently mixed with other liquids to develop cough syrups for colds and flu. It has frequently been used for pain relief after removal of tonsils and adenoids in children.

After an investigation, the FDA restricted the use of codeine and tramadol in children under 12 and recommend against their use in children between 12 and 18 years of age. Additionally, the FDA has warned breastfeeding mothers not to take these medications due to the risk of serious adverse reactions in breastfed infants.

Shutterstock

Heroin —

You can't get heroin by prescription, but many heroin users start off abusing prescription opioids, then turn to this illegal opioid.

CNN's Chief Medical Correspondent Dr. Sanjay Gupta has reported on recent research that shows today's typical heroin addict starts using at 23, is more likely to live in affluent suburbs and was likely unwittingly led to heroin through painkillers prescribed by his or her doctor.

According to the CDC, deaths from overdoses of prescription drugs and heroin continue to be the leading cause of unintentional death for Americans, rising 14% from 2013 to 2014.

Mukhina Viktoriia/Shutterstock

Fentanyl —

Fentanyl citrate, pictured here, is a Class II controlled substance and one of the most powerful opioids on the market. It's often administered via injection or transdermal patch, or in lozenge form for pain after surgery, for difficult-to-manage chronic pain and for people who have developed a tolerance to other opioids.

The type of fentanyl usually associated with overdoses is bought on the street in powder or pill form and is often mixed with heroin in a clandestine lab to increase the high it produces. Street names include Apache, China girl, goodfella, jackpot, murder 8, TNT and Tango and Cash.

Joe Amon/Denver Post/Getty Images

Hydrocodone —

These pills are a more powerful form of codeine, called hydrocodone, and are often mixed with acetaminophen. Hydrocodone is the most frequently prescribed opioid painkiller, according to the U.S. Food and Drug Administration, and the most abused. An overdose of hydrocodone can cause "cold and clammy skin, severely constricted pupils, and slow breathing that can lead to a loss of consciousness and death."

Joe Amon/Denver Post/Getty Images

Oxycodone —

Oxycodone is a powerful narcotic pain reliever prescribed for moderate to high pain relief. It's often given in an extended-release formula for patients who will need to be on pain medications for long periods of time.

Patients are warned not to break, chew, crush or dissolve extended-release tablets because the rush of oxycodone into the system could cause serious health problems, including overdose and death.

Though highly addictive, oxycodone is not thought to be as frequently abused as hydrocodone. OxyContin, Percocet, Percodan and Tylox are some trade-name oxycodone products.

Education Images/UIG/Getty Images

Morphine —

Morphine is another powerful opioid often administered via syringe for severe pain. It can come in pill form, usually as extended-release tablets and capsules, and is prescribed only to relieve difficult, chronic pain that cannot be controlled by the use of other pain medications.

As with most opioids, mixing medications, drinking alcohol or taking other meds that contain alcohol, or using street drugs while taking morphine, increases the risk of breathing problems or other serious, life-threatening side effects.

UniversalImagesGroup/UIG/Getty Images

Meperidine —

Meperidine is another narcotic analgesic, similar to morphine. It's often used to help put people to sleep before an operation and to provide pain relief after childbirth.

The most common brand name is Demerol, which comes in both tablet and liquid forms. It is usually taken with or without food every three or four hours as needed for pain.

As with all opioids, meperidine can cause drowsiness, so never drive a car or operate machinery after taking it until you know how you will react.

DEA

Hydromorphone —

Hydromorphone is another highly potent prescription painkiller. It's most commonly known by the brand names Dilaudid, pictured here, and Exalgo.

Liquid hydromorphone holds the dubious honor of being frequently mistaken for morphine in hospital "wrong drug" medication errors because of the similarity of the names and appearances.

Joe Amon/Denver Post/Getty Images

Methadone —

Though methadone is used to relieve severe chronic pain, it's most commonly known for preventing withdrawal symptoms in patients who were addicted to opioid drugs, as a part of their recovery process.

Methadone has many of the same side effects as other opioids, including weakness, headache, nausea and vomiting, stomach pain, sweating, difficulty urinating, mood changes and vision problems, and difficulty falling asleep or staying asleep.

Whitney Hayward/Press Herald/Getty Images

Buprenorphine —

Buprenorphine is a opioid used as an alternative to methadone to help addicts recovering from heroin use. Buprenorphine is different from other opioids because it's a "partial opioid agonist," which means that when taken in proper prescribed doses, it should produce less euphoria and physical dependence, and therefore a lower potential for misuse. It's also supposed to have a relatively mild withdrawal profile.

However, if abused by crushing and snorting or injecting, it can suppress breathing and cause dizziness, confusion, unconsciousness and death.

Subutex, the brand name for buprenorphine, is taken as a tablet placed under the tongue and allowed to dissolve.

The brand Suboxone is a combination of buprenorphine and naloxone, an opioid antagonist. Antagonists block the opiate receptors in the brain, keeping the narcotic from creating the high abusers crave.

Joe Raedle/Getty Images

Opioids: Addictive painkillers

Story highlights

Both types of drugs can slow breathing and lead to overdose

The number of overdose deaths involving both drugs nearly tripled from 2004 to 2011

CNN —

In the Food and Drug Administration’s latest move to help stem the tide of drug overdoses, it is now requiring “black-box warnings” on nearly 400 products to warn about the dangers of using opioid painkillers in combination with benzodiazepines, drugs commonly used to treat neurological and psychological conditions including seizure, anxiety and insomnia.

Both opioids, such as hydrocodone and oxycodone, and benzodiazepines, such as diazepam and alprazolam, can slow the central nervous system. Using them together can lead to extreme sleepiness, respiratory depression, coma and death.

The FDA’s highest warning

Black-box warnings, also known as boxed warnings, are the FDA’s highest-level warning. Currently, both opioids and benzodiazepines have varying language about combining drug use, and the new warnings specifically target the use of these two classes of drugs together.

The new warnings are a result of a citizen petition (PDF) made this year by public health physicians who saw an increasing number of emergency room patients who were using both drugs simultaneously.

According to the FDA, between 2004 and 2011, the number of overdose deaths involving the combination of both drugs nearly tripled. In addition, the number of patients prescribed both a narcotic and a benzodiazepine in that same time period increased by 41%, the Centers for Disease Control and Prevention said. Approximately half of all the patients using both drugs had them dispensed on the same day.

When a patient gets his or her prescription filled now, the FDA says, the bottle should have a notification indicating a black-box warning for the drug. The consumer would need to go to the manufacturer’s website for details.

In addition, pharmacists are encouraged to provide patients with an updated medication guide with consumer-friendly language explaining the risks of the drug.

A public health crisis

In a statement, FDA Commissioner Robert Califf said, “It is nothing short of a public health crisis when you see a substantial increase of avoidable overdose and death related to two widely used drug classes being taken together.”

Current CDC guidelines warn doctors against co-prescribing the drugs. Baltimore City Health Commissioner Dr. Leana Wen, who helped lead the petition efforts, said the practice of co-prescribing “was not based on scientific efficacy but common practice.”

Follow CNN Health on Facebook and Twitter

See the latest news and share your comments with CNN Health on Facebook and Twitter.

“We implore health care professionals to heed these new warnings and more carefully and thoroughly evaluate, on a patient-by-patient basis, whether the benefits of using opioids and benzodiazepines – or [central nervous system] depressants more generally – together outweigh these serious risks,” Califf said.