Leana Wen, MD
Commissioner of Health, Baltimore City
My patient was a college student brought into the emergency department after a minor car accident. Although CT scans showed no spinal fractures, he had severe neck pain and spasms. Instinctively, I prescribed Percocet for pain and Valium for muscle spasms. But I didn’t know then what I know now: These two drugs, when taken together, could interact and cost him his life.
Clinicians and the public are often unaware of the threat posed by opioid interaction with another frequently prescribed drug. Why do we continue to prescribe this deadly combination? In part, because that is what we are taught. When I was in medical school in the early 2000s, I learned to treat muscle pain and spasms with both opioids and benzodiazepines, so I routinely prescribed them together. A 2015 study published in the journal Pain Medicine found that one in three patients with chronic pain on opioids was also on benzodiazepines. Just as I acted on instinct with my patient in the ED, as doctors we prescribe medications based on habit.
Most overdose-education campaigns, including ours in Baltimore City, focus exclusively on the opioid epidemic. Likewise, education for physicians has focused on increasing monitoring of opioid prescriptions, rather than on decreasing their use with benzodiazepines. But with mounting scientific and epidemiological evidence about this deadly combination, we must adjust our patterns.
In Baltimore, we recognize the importance of working together as physicians to confront this challenge, and our Health Department recently sent a letter on the best practices of opioid prescription to every doctor in our city. This letter has 4 components: 1) Being judicious about opioid prescribing; 2) Requiring co-prescribing of naloxone with opioids; 3) Avoiding co-prescribing benzodiazepines with opioids; 4) Informing patients about our city’s 24/7 hotline and using it as a resource.
When I look back at my practice, I wonder how many deaths my colleagues and I might have caused inadvertently—and how many we could have prevented if we had known the potential dangers sooner. It’s a harrowing thought that should spur us as doctors to change our prescribing practices and patients to look inside their medicine cabinets.