Public health directors across the United States are pressuring the Food and Drug Administration (FDA) to put a “black box” warning, the agency’s strongest warning, on prescription painkillers and sedatives. 
The demand, which comes in the form of a petition, comes as cities and states grapple with a growing epidemic of painkiller abuse.
The officials write in the petition submitted Monday:
“Only a few labels and medication guides contain specific information on the dangers of concurrent use of these two classes of medications; none contain black box warnings.”
The health directors want the warning to read:
“WARNING: CONCURRENT USE WITH BENZODIAZEPINES [replace with OPIOIDS on benzodiazepine labels] REDUCES THE MARGIN OF SAFETY FOR RESPIRATORY DEPRESSION AND CONTRIBUTES TO THE RISK OF FATAL OVERDOSE, PARTICULARLY IN THE SETTING OF MISUSE.” 
The Centers for Disease Control and Prevention (CDC) recently reported that opioid overdose deaths rose to nearly 19,000 in the United States in 2014, the most recent year on record. The prescription painkillers have also played a role in a wave of heroin overdoses in recent years, which is cheaper and easier to access than opioid drugs.
A study published last week in the American Journal of Public Health shows that overdose deaths have been soaring among Americans who use benzodiazepines, or “benzos,” a class of sedatives that includes Valium and Xanax. Researchers found that the death rate from overdoses of the drugs increased more than 4-fold since 1996. Benzo overdoses accounted for nearly 1/3 of the 23,000 deaths attributed to prescription drug overdoses in the U.S. in 2013.
Health officials noted in the petition that benzodiazepine-opioid combinations are especially deadly, and they are frequently prescribed together. For example, it is common for doctors to prescribe an opioid to a patient with acute pain, along with a benzodiazepine to treat muscle spasms. Often, an opioid is prescribed to treat pain alongside a benzodiazepine to treat a patient’s anxiety disorder.