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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. Benzos are often thought of as benign. But they are addictive and when mixed with other drugs, they can be deadly.

From the Maine Public Broadcasting Network, Susan Sharon reports.

SUSAN SHARON, BYLINE: When they first burst onto the scene in the 1960s, benzodiazepines - and in particular, Valium - quickly became known as mother's little helper, the mild tranquilizer that could soothe frazzled housewives' nerves. More than four decades later, benzos - including Xanax, Klonopin and Ativan - are among the most widely prescribed medications used to treat anxiety, mood disorders and insomnia.

DR. MICHAEL KELLEY: So this is the Behavioral Emergency Department at St. Mary's.

SHARON: Dr. Michael Kelley says he doesn't go a single day without seeing somebody addicted to them.

KELLEY: It's a completely enclosed, psychiatric emergency room that treats chemical dependency and psychiatric patients. It's got separate...

SHARON: Kelley is the medical director at the hospital's behavioral department in Lewiston, Maine. 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, which are both sedatives that can slow respiration.

KELLEY: It's actually pretty rare to see somebody only using only one.

SHARON: And that is very dangerous.

KELLEY: Very dangerous. The benzodiazepines and the opiates both can cause death when you take too much of them. But they potentiate each other. They make each other stronger. And so one plus one doesn't equal two. It equals three or four, if that makes sense.

SAYRA SMALL: It makes it so you have no problem. I mean, the house could burn down and you'd just sit there saying OK, this is all right.

SHARON: In her early 20s, Sayra Small says she found it very easy to find a doctor willing to prescribe benzos for her anxiety. She loved them because they worked so well. The problem was, she was also addicted to prescription painkillers and heroin and pretty soon, Small says she was dependent on benzos, too.

SMALL: 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 or whatnot. And that stops happening after awhile, 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.

SHARON: 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 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.

DR. MARK PUBLICKER: 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.

SHARON: Sayra 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.

SMALL: 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. It was - but emotionally, you just feel stripped. You feel naked to the world.

SHARON: Now 34, Small has been in recovery for three years. She still gets anxious. But she says she's learned to deal with life on her own terms, without relying on the medications she thought were her friends.

For NPR News, I'm Susan Sharon.

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