Understanding your medication

Risky alone, toxic together

Reducing the risk of overdoses with opioids, benzodiazepines, pregabalin and tricyclic antidepressants

Overdoses can involve prescribed medicines; medicines bought at a shop, pharmacy or on-line. They can involve illegal “street drugs” or alcohol. Overdoses are often accidental. The medicines or drugs might be the person’s own property or someone else’s to which they have access.

Many of the medicines we use can be dangerous in overdose. There are particular concerns about the ones mentioned here.

Opioids are natural drugs derived from the opium poppy, or artificial drugs that do the same things.

Opioids act in the brain and nervous system to block pain signals. Commonly used opioids include oxycodone, morphine, codeine, fentanyl, heroin, methadone and buprenorphine.

Benzodiazepines are drugs that cut-down overactivity of the brain and nervous system. They are often given to help with pain, help you to sleep or to feel less anxious. Commonly used benzodiazepines include diazepam (Valium), lorazepam and temazepam. Alprazolam (Xanax) is a benzodiazepine that is not used by the NHS but is increasingly of concern to drug misuse services.

Opioids and benzodiazepines reduce normal, automatic functions like breathing. If an overdose is taken, the person may stop breathing and die.

Pregabalin is a medicine for treating epilepsy, pain or anxiety. Pregablin increases the effect of opioids in reducing breathing. At higher doses it directly reduces breathing. Pregabalin seriously increases the harm caused by an opioid overdose.

Tricyclic antidepressants (TCAs) are used to treat depression, anxiety and long-term pain. Commonly used TCAs include amitriptyline, clomipramine and imipramine.  In overdose TCAs can stop the heart.

The chance of overdose and the amount of harm is increased by taking:

• high doses of these medicines
• a combination of these medicines, because their effects add-up
• alcohol with these medicines, because alcohol increases their effects
• street drugs with these medicines, because their effects might add-up

Opioids, benzodiazepines, TCAs and pregabalin are still useful medicines when used properly and safely. There are a number of things that can be done to keep people safe.

TIPS FOR STAYING SAFE

• Store medicines safely, where children and pets can’t get at them.
• Don’t assume one prescriber knows all the details of how another team is treating you. Tell healthcare professionals about all of the medicines or drugs that you are using and how much you take. This helps them to make the best and safest decisions. A psychiatrist prescribing benzodiazepines may not know exactly how much opioid medication you are prescribed by your GP or pain clinic, unless you let them know.
• If you take a number of the medicines in this leaflet, ask your doctor or pharmacist if it is safe to carry on.
• If you are prescribed a medicine, ask how long you should take it for. Opioids and benzodiazepines are usually used only for short periods.
• Don’t mix prescription medicines with ones you have bought, unless you have checked they are safe together.
• If you have been in hospital, check which medicines and doses have been stopped, started or changed. Make sure your next prescription from your GP matches what you expect. If it doesn’t, ask why.
• If you have any questions about the medicines you are prescribed, talk to one of your healthcare professionals. This might be a doctor, pharmacist or nurse. Ask about things like side effects or if you feel the medicine is becoming less effective.
• Don’t change your medication dose without discussing it with a healthcare professional. Larger doses increase the risk of overdose. Smaller doses or stopping medicines suddenly might make you unwell.
• Don’t keep more medication in your house than you really need. This increases the chance of taking too much.
• Don’t keep unwanted medicines. Take them to your usual pharmacy to be safely destroyed without damaging the environment.
• If you buy prescription medicines over the internet, read our handy fact-sheet about the dangers.

If you don’t feel safe with your medicines, please talk to someone. Your doctor, nurse or pharmacist can help you.