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 diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin), work by increasing the activity of a neurotransmitter called GABA in the brain. GABA has a calming effect, which helps to reduce anxiety, promote relaxation, and induce sleep. While effective for these purposes, it’s crucial to understand what benzo is and the significant risks associated with its use, especially when combined with other substances like opioids.
In 2021, alarming statistics revealed that nearly 14% of opioid overdose deaths also involved benzodiazepines.3 This concerning overlap highlights the dangers of using these central nervous system depressants together. The Centers for Disease Control and Prevention (CDC) warns about the increased risk of life-threatening overdose when opioids are taken with benzodiazepines, alcohol, or even substances like xylazine.1,2 This risk arises because both opioids and benzodiazepines can cause sedation and suppress breathing, the critical factor leading to overdose fatalities.
Line graph showing national overdose deaths involving any opioid, by Benzodiazepine involvement – All ages 2000-2020. Any opioid deaths: 68,630. Any opioid and benzodiazepines deaths: 10,771
The Mechanism of Benzos: How Do Benzodiazepines Work?
To fully grasp the risks, it’s important to understand how benzos function in the body. Benzodiazepines enhance the effect of GABA (gamma-aminobutyric acid), a neurotransmitter that slows down brain activity. By boosting GABA’s effects, benzos can effectively calm the nervous system, reduce excitability in the brain, and produce a sedative effect. This mechanism is why they are prescribed for conditions like:
- Anxiety Disorders: Benzos can help manage symptoms of generalized anxiety disorder, panic disorder, and social anxiety disorder by reducing excessive worry and fear.
- Insomnia: Their sedative properties make them useful for short-term treatment of sleep difficulties, helping individuals fall asleep and stay asleep.
- Seizure Disorders: Benzos can be effective in controlling seizures due to their ability to reduce brain excitability.
- Muscle Spasms: Certain benzodiazepines can relax muscles and alleviate muscle spasms.
- Alcohol Withdrawal: They are also used to manage withdrawal symptoms from alcohol, as they can help prevent seizures and reduce agitation.
However, this powerful calming effect also contributes to the dangers when benzos are misused or combined with other central nervous system depressants.
Dangers of Combining Benzos and Opioids: A Deadly Mix
The concurrent use of benzodiazepines and opioids is particularly dangerous due to their synergistic depressant effects on the central nervous system. Opioids, prescribed for pain relief, also slow down breathing and brain function. When combined with benzos, these effects are amplified, significantly increasing the risk of:
- Respiratory Depression: Both drug types can suppress breathing. When taken together, this effect is intensified, potentially leading to dangerously slow or stopped breathing, the primary cause of overdose death.
- Overdose: The combined sedative effects can lead to a loss of consciousness, coma, and ultimately, fatal overdose.
- Cognitive Impairment: Both substances impair cognitive functions, including judgment, coordination, and reaction time. This impairment increases the risk of accidents, falls, and injuries.
- Increased Risk of Emergency Room Visits and Hospitalization: Studies have shown that individuals using both opioids and benzodiazepines are at a significantly higher risk of drug-related emergencies requiring medical intervention.4,5
Research consistently highlights the amplified dangers of this drug combination. For instance, a study in North Carolina revealed that the overdose death rate among patients prescribed both opioids and benzodiazepines was ten times higher compared to those only receiving opioids.6 Similarly, research on U.S. veterans with opioid prescriptions indicated that receiving a benzodiazepine prescription was linked to an elevated risk of overdose death, and this risk increased with higher doses of benzodiazepines.7
Benzodiazepines in the Illicit Drug Supply
Adding to the complexity and danger, researchers have detected benzodiazepines in the illicit opioid supply in certain areas.2 This presence means individuals may unknowingly be taking benzos when they believe they are only using illicit opioids. This unintentional co-use further elevates the risk of overdose and underscores the unpredictable nature of the illicit drug market.
Safe Prescribing and Patient Awareness
Recognizing these significant risks, health organizations are taking steps to mitigate harm. The CDC’s Clinical Practice Guideline for Prescribing Opioids for Pain emphasizes the need for clinicians to exercise extreme caution when considering prescribing benzodiazepines alongside opioids.8 The guideline recommends a careful evaluation of whether the benefits of co-prescribing outweigh the substantial risks for each patient.
Furthermore, both prescription opioids and benzodiazepines now carry “boxed warnings” from the U.S. Food and Drug Administration (FDA) on their labels. These boxed warnings, the FDA’s strongest form of warning, explicitly highlight the serious and potentially life-threatening dangers associated with using these drugs in combination.
For individuals prescribed either benzodiazepines or opioids, or both, open communication with healthcare providers is paramount. Patients must disclose all other medications and substances they are using to allow for a comprehensive risk assessment. Healthcare teams can then provide informed guidance on managing or avoiding the risks of drug interactions and ensure patient safety.
References
- Taking opioids in combination with other central nervous system depressants—like benzodiazepines, alcohol, or xylazine—increases the risk of life-threatening overdose. https://www.cdc.gov/
- 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. https://www.drugabuse.gov/
- In 2021, nearly 14% of overdose deaths involving opioids also involved benzodiazepines. Centers for Disease Control and Prevention, National Center for Health Statistics. https://www.cdc.gov/nchs/
- 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. https://www.ncbi.nlm.nih.gov/
- 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. https://jamanetwork.com/
- 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. https://www.ncbi.nlm.nih.gov/
- 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. https://pubmed.ncbi.nlm.nih.gov/
- 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. https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
