Taking opioids with other central nervous system depressants, such as Benzo Medication, alcohol, or xylazine, significantly elevates the risk of a life-threatening overdose.1,2 It’s crucial to understand the dangers of polysubstance use, especially when it involves prescription drugs like benzodiazepines, often referred to as “benzos.”
In 2021, data indicated that nearly 14% of opioid overdose fatalities also involved benzodiazepines.3 Benzo medication, prescribed mainly to manage anxiety and insomnia, works by increasing the levels of GABA, an inhibitory neurotransmitter, in the brain, leading to a calming or sedative effect. Common examples of benzo medication include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin).
Alarmingly, benzodiazepines have been detected in the illicit opioid supply in certain regions.2 This suggests that individuals might be unknowingly or knowingly consuming benzo medication alongside illicit opioids.
The Dangers of Co-Prescribing Opioids and Benzo Medication
Every day, approximately 220 Americans succumb to opioid overdoses.3 The concurrent use of opioids and benzo medication intensifies overdose risks because both drug types can induce sedation and respiratory depression – the primary cause of overdose deaths. Furthermore, this combination impairs cognitive functions. Research highlights that individuals using opioids and benzo medication together face a heightened risk of emergency room visits, hospital admissions for drug-related emergencies, and fatal overdoses.4,5
For instance, a study conducted in North Carolina revealed that the overdose death rate among patients prescribed both opioids and benzo medication was ten times higher compared to those only receiving opioids.6 Another study focusing on U.S. veterans with opioid prescriptions found a dose-dependent correlation between receiving a benzo medication prescription and an increased risk of drug overdose death.7
The Centers for Disease Control and Prevention (CDC) emphasizes caution in their Clinical Practice Guideline for Prescribing Opioids for Pain. They recommend clinicians to carefully evaluate the benefits versus risks when prescribing benzo medication alongside opioids.8 Both prescription opioids and benzodiazepines now carry FDA boxed warnings, the strongest form of warning, on their labels, emphasizing the potential hazards of combining these medications.
It is vital for anyone prescribed medication to inform their healthcare providers about all substances and medications they are using. Consulting with healthcare teams about the risks associated with combining medications and substances is crucial for managing and avoiding potential dangers.
References
- National Institute on Drug Abuse. (2023, January 19). Benzodiazepines and Opioids. National Institutes of Health. https://nida.nih.gov/drug-topics/opioids/benzodiazepines-opioids
- Olfson, M., King, M., & Schoenbaum, M. (2015). Trends in Opioid and Benzodiazepine Prescriptions Among U.S. Adults, 2003-2012. JAMA Internal Medicine, 175(3), 481–482.
- Centers for Disease Control and Prevention. (2022, December 16). Provisional Drug Overdose Death Counts. National Center for Health Statistics. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
- Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. American Journal of Public Health, 108(2), 182–186.
- Park, T. W., Saitz, R., Ganoczy, D., Ilgen, M. A., & Bohnert, A. S. B. (2015). Concurrent Opioid and Benzodiazepine Use and Risk of Mortality Among Patients Receiving Opioids for Chronic Pain. JAMA Psychiatry, 72(11), 1161–1170.
- Gomes, T., Juurlink, D. N., Dhalla, I. A., Mailis-Gagnon, A., Paterson, J. M., & Mamdani, M. M. (2011). হাসপাতালে Admission and Death During Concurrent Use of Opioids and Benzodiazepines. New England Journal of Medicine, 365(11), 1019–1028.
- Bohnert, A. S. B., Ilgen, M. A., Galea, S., McCarthy, J. F., Valenstein, M., & Blow, F. C. (2011). Association Between Benzodiazepine Use and Opioid Overdose Among Patients Prescribed Opioids for Chronic Pain. JAMA, 307(20), 2065–2072.
- Dowell, D. (2016). CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR. Recommendations and Reports, 65(RR-1), 1–49.
