What Are Benzos Drugs? Understanding the Risks of Benzodiazepines

Benzodiazepines, often referred to as “benzos,” are a class of prescription medications primarily used to treat anxiety, insomnia, and seizures. While effective for these conditions when used as prescribed, it’s crucial to understand what benzos are, how they work, and the significant risks associated with their misuse, especially when combined with other substances like opioids. This is particularly important given the alarming statistics surrounding drug overdoses.

In 2021, data indicated a worrying trend: nearly 14% of opioid overdose deaths also involved benzodiazepines.3 This highlights a critical public health concern regarding polysubstance use – the use of more than one drug at the same time. The Centers for Disease Control and Prevention (CDC) provides further information on the effects of polysubstance use.

Benzodiazepines Explained: How Do Benzos Drugs Work?

Benzodiazepines are central nervous system depressants. They function by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. By increasing GABA levels, benzos slow down brain activity, producing a calming and sedative effect. This mechanism is why they are effective in treating conditions characterized by overactivity in the brain, such as anxiety disorders and insomnia.

Commonly prescribed benzodiazepines include:

• Diazepam (Valium): Often used for anxiety, muscle spasms, and seizures.
• Alprazolam (Xanax): Primarily prescribed for anxiety and panic disorders.
• Clonazepam (Klonopin): Used to treat seizures and panic disorder.
• Lorazepam (Ativan): Used for anxiety and as a pre-anesthetic medication.
• Temazepam (Restoril): Primarily used for short-term treatment of insomnia.

These medications are powerful and require careful medical supervision. Despite their therapeutic benefits, benzodiazepines also carry significant risks, especially when misused or combined with other substances.

The Heightened Overdose Risk: Benzos Drugs and Opioids

The combination of benzodiazepines and opioids is particularly dangerous and can dramatically increase the risk of a life-threatening overdose.1,2 Opioids, another class of central nervous system depressants, are often prescribed for pain relief. Like benzos, they can cause sedation and respiratory depression.

When taken together, benzos and opioids have a synergistic effect, meaning they amplify each other’s depressant effects on the central nervous system. This combination can lead to:

• Severe Sedation: Both drugs can cause drowsiness and reduced alertness. When combined, this effect is intensified, leading to profound sedation and loss of consciousness.
• Respiratory Depression: Both opioids and benzodiazepines can suppress breathing. Combined use significantly increases the risk of slowed or stopped breathing, the primary cause of overdose fatality.
• Impaired Cognitive Function: Both drug types can impair thinking, judgment, and coordination. Concurrent use worsens these impairments, increasing the risk of accidents and injuries.

Research has consistently shown the dangers of this drug combination. Studies indicate that individuals using both opioids and benzodiazepines are at a significantly higher risk of emergency room visits, hospitalization for drug-related emergencies, and fatal overdose.4,5 A study in North Carolina revealed that the overdose death rate was ten times higher for patients receiving both medication types compared to those only on opioids.6 Similarly, research on U.S. veterans with opioid prescriptions found that benzodiazepine prescriptions were linked to an increased risk of overdose death, with the risk escalating with higher doses of benzos.7

Safe Prescribing and Patient Responsibility

Recognizing these dangers, health organizations have issued strong warnings and guidelines. The CDC’s Clinical Practice Guideline for Prescribing Opioids for Pain emphasizes the need for extreme caution when prescribing benzodiazepines with opioids, urging clinicians to carefully weigh the benefits against the risks.8 Furthermore, both prescription opioids and benzodiazepines now carry a U.S. Food and Drug Administration boxed warning – the agency’s most serious warning – highlighting the potentially fatal risks of using these drugs together.

It is crucial for anyone prescribed benzodiazepines or opioids to be fully transparent with their healthcare provider about all other medications and substances they are using, including alcohol and illicit drugs. Open communication with healthcare teams is essential to manage and mitigate the risks associated with combining these substances. Understanding “What Are Benzos Drugs” and their potential dangers, especially in combination with other depressants, is a vital step in promoting patient safety and preventing tragic overdose outcomes.

References

1. Taking opioids in combination with other central nervous system depressants—like benzodiazepines, alcohol, or xylazine—increases the risk of life-threatening overdose.
2. Researchers have also found benzodiazepines in the illicit opioid supply in some areas, which may mean that people are taking benzodiazepines in combination with illicit opioids knowingly or unknowingly.
3. In 2021, nearly 14% of overdose deaths involving opioids also involved benzodiazepines, a type of prescription sedative commonly prescribed for anxiety or to help with insomnia.
4. Research shows that people who use opioids and benzodiazepines concurrently are at higher risk of visiting the emergency department, being admitted to a hospital for a drug-related emergency, and dying of drug overdose.
5. Research shows that people who use opioids and benzodiazepines concurrently are at higher risk of visiting the emergency department, being admitted to a hospital for a drug-related emergency, and dying of drug overdose.
6. A cohort study in North Carolina found that the overdose death rate among patients receiving both types of medications was 10 times higher than among those only receiving opioids.
7. A study among U.S. veterans with an opioid prescription found that receiving a benzodiazepine prescription was associated with increased risk of drug overdose death in a dose-dependent manner.
8. The Centers for Disease Control and Prevention (CDC) Clinical Practice Guideline for Prescribing Opioids for Pain recommends that clinicians use particular caution when prescribing benzodiazepines concurrently with opioids and consider whether benefits outweigh risks.