When actor Philip Seymour Hoffman died of an overdose in February, the New York City medical examiner ruled that his death was the result of "acute mixed drug intoxication." Heroin, cocaine and a widely prescribed class of drugs known as benzodiazepines, or benzos, were found in his system.
The drugs first burst onto the scene in the 1950s and '60s and quickly became known as "mother's little helper," the mild tranquilizer that could soothe frazzled housewives' nerves. More than four decades later, benzos including Valium, Xanax, Klonopin and Ativan are used to treat anxiety, mood disorders and insomnia.
Dr. Michael Kelley, the medical director of the behavioral department at St. Mary's Regional Medical Center in Lewiston, Maine, says he doesn't go a single day without seeing somebody addicted to them.
He says when he first took the job 15 years ago, about 75 percent of the detox patients were alcoholics, and the rest were drug addicts. Now, he says, 90 percent of them are drug addicts whose drugs of choice often include the combined use of opiates and benzos; both are sedatives that can slow respiration.
"It's actually pretty rare to see somebody only using only one," he says and that's incredibly dangerous.
"Benzodiazepines and the opiates both can cause death when you take too much of them," he adds. "But they potentiate each other they make each other stronger. And so one plus one doesn't equal two; it equals three or four."
Sayra Small says that in her early 20s, it was easy to find a doctor willing to prescribe benzos for her anxiety. She loved them because they worked so well. "It makes it so you have no problem," she says. "I mean the house could burn down and you'd just sit there saying, OK, this is all right."
The problem was, she was also addicted to prescription painkillers and heroin. And pretty soon, Small says, she was dependent on benzos, too.
"When you first start using opiates you instantly get the rush. Well, for me, I loved the rush but that wasn't about it. It was the feeling afterwards of just feeling so content. Lots of people call it 'the nod,' " she says. "And that stops happening after a while just using opiates. So, it's the benzos and opiates together that still produce that nod. It feels very easy when you're feeling that way, too, like you could just slip away."
Small almost did slip away. She says she overdosed several times before getting into recovery but she was lucky. Data from the Centers for Disease Control and Prevention show that the combination of benzos and opioids contribute to about 30 percent of opioid-related deaths.
Small ended up in the care of Dr. Mark Publicker, an addiction specialist with the Mercy Recovery Center in Westbrook, Maine. He says he thinks the risks associated with benzos have been overshadowed by the prescription opioid epidemic.
"They do produce a strong, physical dependence that can create life-threatening withdrawal seizures and other consequences, but I think that the perception that they're harmful is low," he says.
Small learned that the hard way. She says her detox for benzos was far more difficult than it was for the opioid painkillers she was also abusing. "I mean, I couldn't move, I couldn't eat. I don't want to say anything too graphic, but anything you had came out one end or the other.
"But emotionally," she says, "you just feel stripped. You feel naked to the world."
Now 34, Small has been in recovery for a couple of years. She still gets anxious but says she's learned to deal with life on her own terms, without relying on the medications she thought were her friends.