The dangers of mixing drugs are widely known, but the combination of opioids and benzodiazepines (“benzos”) presents a particularly heightened risk of life-threatening overdose. This is because both drug types depress the central nervous system. It’s crucial to understand this potentially fatal interaction, especially given the prevalence of both types of medications.
Benzodiazepines, commonly referred to as “Benzos Drugs”, are a class of prescription sedatives frequently used to treat anxiety and insomnia. These medications, including well-known names like diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin), work by increasing the activity of GABA, a neurotransmitter that slows down brain activity. While effective for their prescribed uses, benzos drugs carry significant risks, especially when combined with other substances.
Statistics from 2021 reveal a concerning trend: nearly 14% of opioid overdose deaths also involved benzodiazepines. This alarming figure underscores the severity of the interaction between opioids and benzos drugs. Furthermore, research has indicated the presence of benzodiazepines in the illicit opioid supply in certain regions. This raises the possibility of unintentional co-use, where individuals may unknowingly be taking benzos drugs alongside illicit opioids.
The Perilous Combination: Opioids and Benzos Drugs
Every day, approximately 220 lives are lost in the United States due to opioid overdoses. The concurrent use of opioids and benzos drugs dramatically escalates this risk. Both substances are central nervous system depressants, meaning they can induce sedation and, critically, suppress breathing. Respiratory depression is the primary cause of overdose fatality. When taken together, these effects are amplified, leading to a significantly greater chance of respiratory failure and death. Beyond the immediate overdose risk, combining benzos drugs and opioids can also severely impair cognitive functions, increasing the likelihood of accidents and injuries.
Studies have consistently demonstrated the heightened dangers of this drug combination. Individuals who use both opioids and benzos drugs are at a considerably higher risk of emergency room visits, hospitalization for drug-related emergencies, and, tragically, fatal overdose. For instance, a study conducted in North Carolina revealed a staggering statistic: the overdose death rate among patients prescribed both opioids and benzos drugs was ten times higher compared to those only receiving opioids. Another study focusing on US veterans with opioid prescriptions found a direct correlation between receiving benzo prescriptions and an increased risk of overdose death, with the risk escalating with higher benzo dosages.
Recognizing these dangers, the Centers for Disease Control and Prevention (CDC) has issued explicit guidelines in their Clinical Practice Guideline for Prescribing Opioids for Pain. The CDC strongly advises clinicians to exercise extreme caution when considering prescribing benzos drugs alongside opioids, emphasizing a careful evaluation of whether the potential benefits outweigh the substantial risks. Adding to these warnings, both prescription opioids and benzodiazepines now feature U.S. Food and Drug Administration (FDA) boxed warnings on their packaging. These boxed warnings, the FDA’s most stringent safety alerts, specifically highlight the potentially fatal dangers associated with the combined use of these drug classes.
It is paramount for anyone prescribed either opioids or benzos drugs, or both, to have open and honest conversations with their healthcare providers. Disclosing all medications and substances being used is crucial. Healthcare teams can then provide informed guidance on managing or avoiding the serious risks associated with combining these and other substances. Understanding the dangers of mixing benzos drugs with opioids is a vital step in preventing tragic and avoidable overdoses.
References
[1] National Institute on Drug Abuse. (2023, August 7). Benzodiazepines and Opioids. National Institutes of Health. Retrieved from https://nida.nih.gov/drug-topics/opioids/benzodiazepines-opioids
[2] Centers for Disease Control and Prevention. (n.d.). Polysubstance Use. Retrieved from https://www.cdc.gov/stop-overdose/caring/polysubstance-use.html
[3] Centers for Disease Control and Prevention. (2023, March 17). Overdose Deaths Involving Benzodiazepines. National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db465.htm
[4] Park, T. W., Saitz, R., Ganoczy, D., Ilgen, M. A., & Bohnert, A. S. B. (2015). Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study. BMJ, 350, h2698.
[5] Dasgupta, N., Funk, M. J., Proescholdbell, S., Hirsch, A., & Ribisl, K. M. (2011). Cohort study of the impact of benzodiazepine prescriptions on opioid overdose mortality. Pain Medicine, 12(5), 744–751.
[6] Jones, C. M., Mack, K. A., & Paulozzi, L. J. (2013). Pharmaceutical overdose deaths, United States, 2010. JAMA, 309(9), 946–948.
[7] Gomes, T., Juurlink, D. N., Dhalla, I. A., Mailis-Gagnon, A., Paterson, J. M., & Mamdani, M. M. (2011). Co-prescription of opioids and benzodiazepines and risk of mortality from overdose. JAMA, 306(22), 2675–2686.
[8] Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR. Recommendations and Reports, 71(No. RR-3), 1–95.
