Mixing Benzodiazepines and Opioids

Mixing benzos and opioids can be dangerous posing many threats to a person’s health and well-being, the most dangerous being an increased risk of physical injury or opioid overdose.

This article will help you better understand this form of polydrug use, the risks of using opioids and benzos together, and how to get help for drug addiction.

Can You Mix Benzos and Opioids?

Over recent years, the dramatic rise in opioid-involved deaths has become a national public health crisis. At the same time, an increase in prescription and illicit use of benzodiazepines has worsened the problem.¹

When combined, these two medications can have serious and potentially deadly effects, including a heightened risk of respiratory depression, which is the main cause of overdose. And yet, their concurrent use is still somewhat common.¹

In 2017, more than 1 in 5 patients prescribed an opioid were also prescribed a benzodiazepine, and today, an estimated 3 million adults have prescriptions for both types of medications.¹

According to the FDA, doctors who prescribe these two substances together should only do so when alternative treatment options are inadequate. This is because both opioids and benzodiazepines can cause dangerous respiratory depression, other potentially life-threatening symptoms, and overdose.²

However, even though there are known risks, using narcotics and benzos is somewhat common, with one study concluding that 17% of people who used a prescription opioid also used a benzodiazepine.^3,4

Benzodiazepines vs. Opioids

Benzodiazepines and opioids are two separate classes of drugs—each with its own potential effects and risks of use.

Effects of Benzodiazepines

Benzodiazepines are prescription sedatives and central nervous system (CNS) depressants used for different purposes, such as alleviating anxiety, panic attacks, and seizures. Benzodiazepines can cause sleepiness or feelings of relaxation.^2,5,6

However, benzodiazepines have a known potential for dependence, misuse, and addiction.⁷

Common side effects of benzos include:²

• Drowsiness.
• Dizziness.
• Weakness.

The most frequently used benzodiazepines are:⁵

• Alprazolam (Xanax).
• Lorazepam (Ativan).
• Clonazepam (Klonopin).
• Diazepam (Valium).
• Temazepam (Restoril).
• Triazolam (Halcion).

When benzodiazepines are taken alone, long-term use is associated with falls, cognitive impairment, and life-threatening withdrawal.⁸

When taken together with opioids, benzodiazepines can further suppress breathing, a common cause of death from opioid overdose.⁸

Effects of Opioids

Prescription opioids, or narcotics, are typically used to treat moderate-to-severe pain. These drugs are chemically similar to morphine, and people who use them, even as prescribed, are at increased risk of misuse, dependence, addiction, and overdose.⁹

• Drowsiness.
• Nausea.
• Constipation.
• Slowed breathing.

Opioids include:^9,10

• Oxycodone (OxyContin).
• Hydrocodone (Vicodin).
• Codeine.
• Fentanyl.
• Morphine.
• Hydromorphone (Dilaudid).
• Heroin.
• Methadone.
• Buprenorphine.

When opioids are taken alone, long-term use is associated with overdose, dependence, addiction (i.e., opioid use disorder), fractures, myocardial infarction (i.e., heart attacks), poor self-rated health, inactivity, unemployment, higher health care utilization, and poor self-rated quality of life.¹¹

What Are the Effects of Mixing Benzos and Opioids?

Using benzos and opioids together can greatly increase the risk of serious side effects that could lead to serious injuries, opioid overdose, or other adverse outcomes.^2,12

Adverse side effects of both benzos and opioids that are more likely to occur, or are likely to be more severe when the medications are taken together include:^7,13,14

• Extreme sleepiness or sedation.
• Impaired movement and coordination that can increase the risk of falls and injury.
• Cognitive impairment (e.g., trouble remembering things or connecting thoughts).

This combination is also associated with a greater incidence of emergency room visits, hospital admissions, and fatal overdoses.¹²

Benzodiazepine and Opioid Overdose Risks

Combining opioids and benzos greatly increases the risk of overdose. One study found that the risk of fatal overdose was 10 times greater for people who received both types of medications than those who received opioids alone.¹²

The vast majority of benzodiazepine overdoses also involve opioids, with one report indicating that 92.7% of benzodiazepine-involved deaths also involved opioids, and 66.7% involved illicitly manufactured fentanyls.¹⁵

Similarly, prescription opioid overdose deaths also often involve benzodiazepines.⁹

Signs of an overdose on benzos and opioids include:¹⁶

• Slowed, stopped, or irregular breathing.
• Weak pulse.
• Pinpoint pupils.
• Passing out (loss of consciousness).

What to Do in the Event of an Overdose

An overdose is a life-threatening emergency. If you think someone is overdosing:¹⁶

• Call 911 right away.
• Administer if available.
• Try to keep the person awake and breathing.
• Turn the person on their side to prevent choking.
• Stay with the person until help arrives.

Why Would Someone Mix Benzodiazepines and Opioids?

People mix benzos and opioids for different reasons. One reason could be that it is deemed medically necessary by a doctor, and the person cannot be treated for their condition in another way.²

However, misuse of benzodiazepines and opioids is common among recreational drug users. For example, people who use misuse opioids may also intentionally use or misuse benzos to increase the euphoric feelings or “high” associated with opioids.^5,17

People could also take these substances together accidentally. Benzodiazepines have been found in the illicit opioid drug supply. Likewise, trace amounts of synthetic opioids like fentanyl—which is 50-100 times more potent than morphine—are increasingly being found in counterfeit pills, including illicit benzodiazepines. ^12,18–20

People buying and using these drugs illegally may not realize their pills are laced with other ingredients, and could mix opioids and benzos unknowingly.

Treatment Benzo and Opioid Addiction

If you or a loved one has lost control of their benzo and opioid use, professional addiction treatment can help. At Sunrise House Treatment Center, our inpatient rehab in New Jersey provides personalized, evidenced-based care for people struggling with polysubstance use.

Typically, the recovery process begins with detox. Withdrawal from opioids alone can be unpleasant and uncomfortable. Benzo withdrawal on its own can even be dangerous, involving potentially life-threatening complications like seizures, and polysubstance use can further complicate the process.²¹

Inpatient medical detox can ensure patients are as safe and comfortable as possible. After detox, many patients continue treatment in an inpatient or outpatient setting, where they can address the underlying issues that led to their addiction in the first place.²¹

Treatment may consist of a combination of medications that support withdrawal and post-detox maintenance, as well as counseling and behavioral therapies like cognitive behavioral therapy (CBT).²²

Addiction is treatable, and you can take back control of your life. To get admitted today or learn more about our different types of addiction treatment, insurance coverage for rehab, and other ways to pay for rehab, call us at .

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