It’s a critical question to ask: are benzos opiates? The answer is no, benzodiazepines (often called “benzos”) are not opiates. While both types of drugs can be prescribed to manage various conditions, they belong to different drug classes and affect the body in distinct ways. However, and crucially, combining benzodiazepines with opiates can lead to extremely dangerous, even fatal, consequences.
Benzodiazepines are central nervous system depressants primarily used to treat anxiety, insomnia, and seizures. They work by increasing the activity of GABA, a neurotransmitter that slows down brain activity, producing a calming and sedative effect. Common examples of benzodiazepines include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin).
Opiates, on the other hand, are a class of drugs derived from opium or synthetically produced to mimic its effects. They are powerful pain relievers that work by binding to opioid receptors in the brain and body, reducing the perception of pain and often inducing feelings of euphoria. Examples of opiates include morphine, codeine, and heroin, as well as synthetic opioids like fentanyl and oxycodone.
The danger arises when these two different types of central nervous system depressants are used together. Both benzodiazepines and opiates can cause sedation and, most alarmingly, respiratory depression – a slowing and weakening of breathing. When taken in combination, these effects are amplified, significantly increasing the risk of life-threatening overdose.
Data from 2021 reveals the severity of this issue, with nearly 14% of opioid overdose deaths also involving benzodiazepines. This polysubstance use dramatically elevates the risk of emergency room visits, hospitalization for drug-related emergencies, and ultimately, death by overdose. Studies have shown that individuals concurrently using opioids and benzodiazepines face a significantly higher overdose death rate compared to those using opioids alone.
Health organizations like the Centers for Disease Control and Prevention (CDC) have issued strong warnings regarding the co-prescribing of opioids and benzodiazepines. The CDC’s Clinical Practice Guideline for Prescribing Opioids for Pain emphasizes the need for extreme caution when considering prescribing these medications together, always weighing the benefits against the potentially severe risks. Furthermore, both prescription opioids and benzodiazepines now carry boxed warnings from the U.S. Food and Drug Administration (FDA), the most serious type of warning, clearly highlighting the dangers of combined use.
If you are prescribed either benzodiazepines or opioids, it is crucial to inform your healthcare provider about all other medications and substances you are taking. Open communication with your healthcare team is essential to understand and manage the risks associated with combining medications and to ensure your safety. Recognizing that benzos are not opiates but carry their own set of risks, especially when combined with opioids, is the first step in preventing potentially fatal consequences.
References
[1] National Institute on Drug Abuse. (2023, March 21). Opioid Overdose Crisis. National Institutes of Health. https://nida.nih.gov/drug-topics/opioids/opioid-overdose-crisis
[2] Centers for Disease Control and Prevention. (2023, March 16). Polysubstance Use. National Center for Injury Prevention and Control, Division of Overdose Prevention. https://www.cdc.gov/stop-overdose/caring/polysubstance-use.html
[3] Centers for Disease Control and Prevention. (2023, August 30). Prescription Opioid Overdose Data. National Center for Injury Prevention and Control, Division of Overdose Prevention. https://www.cdc.gov/drugoverdose/rxopioids/overdose-data.html
[4] Park, T. W., Saitz, R., Ganoczy, D., Ilgen, M. A., & Bohnert, A. S. B. (2015). Benzodiazepine Use and Risk of Opioid Overdose Among Individuals Receiving Opioids for Chronic Pain. The American Journal of Psychiatry, 172(12), 1265–1272.
[5] Gomes, T., Juurlink, D. N., Dhalla, I. A., Cornish, S., Holloway, M., & Mamdani, M. M. (2011). Co-prescription of opioid analgesics and benzodiazepines and risk of adverse outcomes: a population-based study. Pharmacoepidemiology and Drug Safety, 20(5), 488–494.
[6] Dasgupta, N., Funk, M. J., Proescholdbell, S., Hirsch, A., & Ribisl, K. M. (2011). Cohort Study of the Impact of Co-prescribing Opioids and Benzodiazepines on Overdose Mortality. Pain Medicine, 12(6), 1079–1088.
[7] 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, 305(23), 2487–2493.
[8] Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR. Recommendations and Reports, 65(RR-1), 1–49.
