Benzodiazepines, often referred to as “benzos,” are a class of prescription medications primarily used to treat anxiety, insomnia, and seizures. These drugs, including common names like Valium, Xanax, and Klonopin, work by increasing the activity of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain. GABA reduces nerve excitability, leading to a calming and sedative effect. While effective for their intended purposes, it’s crucial to understand what benzos are, particularly regarding their potential risks, especially when combined with other substances.
Understanding Benzodiazepines: How Benzos Work
Benzodiazepines are central nervous system depressants, meaning they slow down brain activity. They achieve this by enhancing the effects of GABA, the brain’s natural tranquilizer. When GABA levels are increased, it reduces neuronal activity, resulting in effects like:
- Sedation: Benzos can induce drowsiness and calmness, making them useful for treating insomnia and anxiety-related agitation.
- Muscle Relaxation: They can relax muscles, which is helpful for treating muscle spasms and certain types of seizures.
- Anxiety Reduction: By calming the nervous system, benzos can significantly reduce feelings of anxiety and panic.
- Anticonvulsant Properties: They can help control seizures by stabilizing electrical activity in the brain.
Commonly prescribed benzodiazepines include:
- Diazepam (Valium)
- Alprazolam (Xanax)
- Clonazepam (Klonopin)
- Lorazepam (Ativan)
- Temazepam (Restoril)
While these medications can be beneficial when used as prescribed, it’s essential to be aware of the risks associated with benzodiazepines, especially concerning dependence, withdrawal, and dangerous drug interactions.
The Dangers of Mixing Benzos and Opioids: A Critical Risk
One of the most significant dangers associated with benzodiazepines is the increased risk of overdose when they are combined with other central nervous system depressants, particularly opioids. Opioids, a class of drugs used to manage pain, also depress the central nervous system. Combining these two types of substances can have life-threatening consequences because their combined effects can severely suppress breathing.
The graph illustrates the concerning trend of opioid overdose deaths involving benzodiazepines. In 2021, almost 14% of opioid overdose fatalities also involved benzodiazepines. This alarming statistic underscores the heightened danger of polysubstance use involving these drug classes. Both benzodiazepines and opioids can cause:
- Respiratory Depression: Both drug types can slow and shallow breathing, and when combined, this effect is amplified, potentially leading to respiratory failure and death.
- Sedation and Cognitive Impairment: The combined sedative effects can lead to profound drowsiness, confusion, and loss of coordination, increasing the risk of accidents and injuries.
- Overdose Fatality: Respiratory depression is the primary cause of overdose death, and the synergistic effect of opioids and benzos significantly increases this risk.
Research consistently demonstrates the increased dangers of concurrent use. Studies have shown that individuals who use both opioids and benzodiazepines are at a significantly higher risk of emergency room visits, hospitalization for drug-related emergencies, and fatal overdose.
Co-Prescribing Concerns and Recommendations
The risk is so significant that health organizations like the Centers for Disease Control and Prevention (CDC) have issued guidelines emphasizing caution when prescribing benzodiazepines and opioids together. The CDC’s Clinical Practice Guideline for Prescribing Opioids for Pain recommends that clinicians carefully weigh the benefits against the risks when considering co-prescribing these medications.
Studies have provided stark evidence of these dangers. For instance, a study in North Carolina revealed that the overdose death rate was ten times higher among patients receiving both opioids and benzodiazepines compared to those only on opioids. Similarly, research on U.S. veterans with opioid prescriptions found a dose-dependent increase in overdose death risk associated with benzodiazepine prescriptions.
Both prescription opioids and benzodiazepines now carry boxed warnings from the U.S. Food and Drug Administration (FDA). These boxed warnings, the FDA’s strongest warning type, highlight the serious and potentially life-threatening risks associated with using these drugs in combination.
Unintentional Benzodiazepine Exposure
Adding to the complexity and danger, benzodiazepines have been found in the illicit opioid supply in some regions. This means individuals may unknowingly be taking benzos when they believe they are only taking opioids. This unintentional co-consumption further elevates the risk of overdose and highlights the unpredictable nature of illicit drug use.
Conclusion: Understanding and Mitigating Risks
Understanding what benzos are and their potential dangers, especially in combination with opioids, is crucial for both patients and healthcare providers. While benzodiazepines can be effective medications for specific conditions, their use comes with significant risks, particularly when combined with other central nervous system depressants.
If you are prescribed benzodiazepines or opioids, or both, it is vital to:
- Disclose all medications and substances: Inform your healthcare provider about all prescription drugs, over-the-counter medications, supplements, and substances you use, including alcohol.
- Discuss the risks: Have an open conversation with your doctor about the potential risks of combining medications and substances.
- Adhere to prescribed dosages: Never exceed the prescribed dose of any medication.
- Avoid combining with other depressants: Unless specifically advised by your doctor, avoid combining benzodiazepines with alcohol, opioids, or other sedatives.
By being informed and proactive, individuals can take steps to mitigate the risks associated with benzodiazepines and polysubstance use, protecting their health and well-being.
