Understanding Benzo Use and the Risks of Combining Benzodiazepines with Opioids

The dangers of mixing opioids with other central nervous system depressants, such as benzodiazepines, alcohol, or xylazine, significantly elevate the risk of a life-threatening overdose. It’s crucial to understand Benzo Use in this context, as combining these substances can have fatal consequences. For more detailed information on the effects of polysubstance use, please refer to the U.S. Centers for Disease Control and Prevention (CDC).

In 2021, a concerning statistic emerged: nearly 14% of all opioid overdose fatalities also involved benzodiazepines. Benzodiazepines, often referred to as “benzos,” are prescription sedatives widely used to treat anxiety and insomnia. These medications, including common names like diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin), work by increasing the levels of the neurotransmitter GABA in the brain, which has a calming and sedative effect. This mechanism is effective for their intended medical purposes, but it becomes dangerous when benzo use occurs in combination with other depressants.

Compounding the issue, researchers have detected benzodiazepines in the illicit opioid supply in certain regions. This alarming discovery suggests that individuals might be unknowingly or knowingly engaging in benzo use alongside illicit opioids. This co-use dramatically escalates the risks associated with both substance categories.

The Perilous Practice of Co-Prescribing Opioids and Benzodiazepines

The opioid crisis continues to claim lives, with approximately 220 Americans succumbing to opioid overdose each day. A critical factor exacerbating this crisis is the combined use of opioids and benzodiazepines. Benzo use in conjunction with opioids is particularly dangerous because both drug types induce sedation and depress respiration—the primary cause of overdose deaths. Furthermore, this combination severely impairs cognitive functions, making users even more vulnerable.

Studies have consistently demonstrated that individuals who engage in concurrent opioid and benzo use face a significantly heightened risk of severe health emergencies. These risks include increased emergency department visits, hospital admissions for drug-related emergencies, and tragically, death by drug overdose. The data paints a clear picture of the amplified dangers associated with this drug combination.

For instance, a North Carolina cohort study revealed a stark reality: the overdose death rate among patients prescribed both opioids and benzodiazepines was ten times higher than that of patients only receiving opioids. Similarly, research focusing on U.S. veterans with opioid prescriptions found a direct correlation between benzodiazepine prescriptions and an elevated, dose-dependent risk of fatal drug overdose. These findings underscore the extreme caution needed when considering benzo use in patients already taking opioids.

Recognizing these grave risks, the Centers for Disease Control and Prevention (CDC) has issued explicit guidance in their Clinical Practice Guideline for Prescribing Opioids for Pain. The CDC strongly recommends that clinicians exercise exceptional caution when prescribing benzodiazepines concurrently with opioids. Healthcare providers are urged to carefully weigh the potential benefits against the substantial risks involved in such co-prescriptions. Adding to these warnings, both prescription opioids and benzodiazepines now carry U.S. Food and Drug Administration (FDA) boxed warnings on their packaging. These boxed warnings, the FDA’s most stringent safety alerts, explicitly highlight the potential hazards of combining these medications. This measure aims to ensure that both prescribers and patients are acutely aware of the dangers of combined benzo use and opioid consumption.

It is paramount for anyone prescribed medication to transparently communicate all other substances and medications they are using to their healthcare providers. Open communication enables healthcare teams to effectively manage or mitigate the risks associated with combining certain medications and substances, especially concerning benzo use alongside other central nervous system depressants.

References

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