Mixing Methadone & Benzodiazepines | Effects & Dangers

Despite significant differences in their action and intended use, both methadone (a drug used in opioid use disorder treatment programs) and benzodiazepines (a class of drugs used to control panic and anxiety disorders) are prescribed for valid and necessary reasons. 

However, both can be abused by individuals outside of their proper scope of use. 

While both substances can be harmful if misused on their own, taking both at the same time increases the potential for severe short- and long-term physical and or mental harm.

Effects Of Mixing Methadone & Benzodiazepines

Methadone is a powerful but well-controlled opioid designed to stimulate a person’s opioid receptors at a low level over a long period of time. It works by moderating or blocking opioid withdrawal symptoms and cravings. 

Like all opioid drugs, methadone acts as a central nervous system depressant, slowing down activity in the brain and nervous system while the drug is active in the body. 

Benzodiazepines, on the other hand, include well-known drugs like Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), Valium (diazepam), Librium (chlordiazepoxide), and Restoril (temazepam). 

These drugs are potent CNS depressants and work by increasing the activity of the gamma-aminobutyric acid (GABA) neurotransmitter, which dampens feelings of stress, anxiety, and fear in favor of relaxation and calm.

Intensified Effects Of Both Drugs

When used together, benzos drugs and methadone will synergize or combine, acting together to depress CNS activity along different pathways, or having a larger effect than the drugs have individually. 

This intensifies the effects of both drugs, potentially allowing a person to experience a more intense high (along with more severe adverse effects) depending on the dosage.

If an individual requires treatment with both substances, healthcare providers will generally reduce the dosage of both drugs while monitoring for signs of dangerous sedation/overdose.

Short-Term Risks Of Mixing Methadone & Benzos

Despite being a well-controlled opioid, the combined effects between methadone and benzodiazepines make them a dangerous combination. Individuals should always reveal any forms of drug use before beginning medication-assisted treatment. 

Respiratory Depression & Death

According to the FDA, deaths have been reported when methadone has been abused in conjunction with benzodiazepines. 

This likely occurs due to respiratory depression or arrest, as CNS depressants can slow down breathing to the point where the brain and other organs don’t receive the oxygen they need. 

Overdose

Other serious side-effects of a benzodiazepine or opioid overdose may include:

• blurred vision
• blue-tinted nails or lips
• confusion
• slurred speech
• impaired coordination, movement, and reflexes
• nausea and vomiting
• constricted/pinpoint pupils
• slow or irregular pulse
• low blood pressure
• coma

Long-Term Health Risks Of Mixing Methadone & Benzos

Although some may use methadone and benzodiazepine drugs together to get high, there are serious long-term consequences that come with this type of drug abuse.

Substance Use Disorder

Benzodiazepines and opioid drugs (including methadone) are extremely habit-forming. This means that with chronic use (especially at higher doses) the body will become physically dependent on the substance, which may also develop into psychological addiction.

Mixing substances generally accelerates this process and intensifies the severity of dependence and benzo or opioid addiction that results. 

And while methadone is generally safe to use in the context of methadone maintenance treatment, if its effects are intensified by use of benzodiazepines, it can act as though it were a far more potent opioid drug than it is.

Brain Damage

Chronic abuse of benzodiazepines and opioids is known to cause permanent cognitive and memory impairment as a result of changes in brain structure and function.

Mental Health Effects

The risk of developing depression, anxiety, self-harm, and suicidal ideation may be increased when these substances are mixed.

Sleep Problems

Difficulty falling asleep, poorer quality sleep, and reduced length of sleep are potential effects of drug addiction that includes both opioids and benzodiazepines. 

Reduced Immune Function

Those who abuse drugs, including benzos and opioids, tend to get sick more often and stay sick for longer when they do.

Severe Withdrawal Symptoms

While withdrawing from opioids or benzos can be dangerous or even life-threatening on its own, quitting both together only intensifies the difficulty and danger involved. Professional detox programs or a tapering schedule are likely advised.

Mixing Benzodiazepines & Other Opioid Treatment Drugs

Buprenorphine is a opioid partial agonist that, as with methadone, can be used to temper opioid withdrawal symptoms and cravings. 

Abusing benzodiazepines while taking buprenorphine can lead to severe side effects, including death, similar to concurrent benzodiazepine and methadone use.

Naltrexone, an opioid antagonist that blocks opioid receptors and thus the pleasurable effects of opioids and alcohol, does not interact with benzodiazepine drugs. Accordingly, it is safe for healthcare providers to prescribe both drugs at full dose together if needed. 

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