The Effects & Dangers Of Mixing Benzodiazepines & Opioids

Opioids and benzodiazepines are commonly prescribed medications in the United States. Both drugs are used to treat different conditions but affect the brain in similar ways. When taken together, their depressant effects can intensify and dangerously slow breathing and heart rate. 

Unfortunately, misuse of benzodiazepines and opioids is still common and has increased the number of opioid overdose deaths. According to the National Institute on Drug Abuse (NIDA), in 2019, 16% of opioid overdose deaths also involved benzodiazepines. 

The Effects Of Benzodiazepines And Opioids

Opioids and benzodiazepines are both central nervous system (CNS) depressants that slow brain activity. The use of opioids and benzos intensifies the effects of both drugs, which causes a higher risk of respiratory depression, overdose, and death. 

Benzodiazepines

Benzodiazepines (“benzos”) are used to treat anxiety, insomnia, and seizure disorders. 

Benzodiazepine prescription medications include:

• Xanax (alprazolam)
• Valium (diazepam)
• Ativan (lorazepam)
• Klonopin (clonazepam)

Benzos increase the activity of the neurotransmitter gamma-amino butyric acid (GABA) in the brain. GABA reduces activity between nerve cells, which helps promote feelings of calmness, relaxation, and sleepiness. 

Common side-effects associated with benzodiazepines include:

• slowed reaction time
• impaired motor function
• slurred speech
• dizziness
• memory impairment
• drowsiness

Opioids

Opioids are most commonly used to treat moderate, severe, or chronic pain but are typically only used when other types of pain medication haven’t worked. 

Commonly prescription opioid analgesics (pain medications) include:

• Oxycontin (oxycodone)
• Vicodin (hydrocodone/tylenol)
• Percocet (oxycodone/tylenol)
• morphine
• fentanyl

Opioids also include illicit drugs like heroin and the prescription drug fentanyl, which is sometimes produced in illegal laboratories and sold on the street. 

Opioids bind to opioid receptors in the brain and release an increase of dopamine, a neurotransmitter associated with pleasure and reward. Higher dopamine levels are responsible for the euphoric effects associated with opioid abuse.

Opioids can also cause the following short-term side effects:

• drowsiness
• confusion
• nausea
• vomiting
• dizziness
• constipation

Dangers of Mixing Benzodiazepines And Opioids

Millions of Americans have been impacted by the opioid crisis—opioid medications have been prescribed at increasingly higher rates over the past two decades. Many of the people prescribed opioids were also prescribed benzodiazepines. 

Studies have found that concurrent use of opioids and benzos resulted in an increased risk of emergency department visits and overdose deaths. 

The Centers for Disease Control and Prevention (CDC) guidelines now require the Food and Drug Administration (FDA) to issue warnings on prescription labels about the dangers of co-prescribing opioids and benzodiazepines. 

Overdose

Opioid and benzodiazepine overdoses may result from respiratory depression, which can occur when someone takes high doses of depressant drugs. Respiratory depression affects breathing, heart rate, and other bodily functions. 

The risk of overdose is much greater when opioids are taken with benzos because both drugs slow brain activity. In fact, according to a case-cohort study on benzodiazepine prescribing patterns, about half of opioid overdose deaths also involved benzodiazepines.

Signs of a drug overdose may include:

• slowed breathing
• slowed heart rate
• slurred speech
• confusion
• loss of consciousness
• bluish skin

The effects of an opioid overdose can be reversed with the use of Narcan (naloxone). 

Even if someone has taken benzos and opioids, you should still administer Narcan if you have it on hand and you witness an overdose. Always seek emergency medical attention if you recognize any signs of overdose, even if you have used Narcan. 

Dependence & Addiction

Opioids and benzodiazepines are both controlled substances in the United States. Frequent use of benzodiazepines and opioids, especially in high doses, increases the likelihood of developing dependence and addiction. 

As you develop a tolerance to the drugs, you may need increasingly higher amounts to achieve the same effect. This increases the risk of harmful side effects and you may become dependent on the drug. 

When chemical dependence occurs, withdrawal symptoms will likely occur if you stop or reduce the amount you are taking. 

Dependence increases the risk of developing a substance use disorder (SUD), also known as addiction. Addiction is a complex disease that changes how the brain works and usually results in cravings and loss of control over drug use. 

Addiction Treatment Options

If you or a loved one develops an addiction to one or more substances, professional treatment programs can be beneficial. Inpatient and outpatient programs use evidence-based treatment strategies to help you learn to cope without the use of drugs. 

Addiction specialists and healthcare professionals can help you manage the symptoms of opioid or benzo withdrawal in a medical detox program. 

In the case of opioid addiction, you may be offered prescription medications, like methadone or buprenorphine, to help you manage cravings as part of a medication-assisted treatment program. 

Through group therapy, individual counseling, and behavioral therapy, clinicians can help you learn about addiction, co-occurring mental health disorders, and how to maintain long-term sobriety.

If you would like more information on our addiction treatment options, please contact us today to be connected with a specialist.

Related Topics

Can You Take Benzos On Methadone Treatment? 

While benzodiazepines can be used by individuals participating in methadone treatment for opioid dependence, healthcare providers will likely lower the dose of both substances for safety. 

At higher doses, concurrent use of benzodiazepines and methadone can be hazardous, with a variety of short- and long-term side effects including potential overdose and death.

Learn more about Mixing Methadone & Benzodiazepines