The combination of opioids with other central nervous system (CNS) depressants, such as benzodiazepines, alcohol, and xylazine, significantly elevates the risk of life-threatening overdose. It’s crucial to understand the dangers of polysubstance use, as highlighted by the U.S. Centers for Disease Control and Prevention (CDC).
In 2021, benzodiazepines were involved in almost 14% of opioid overdose deaths. Benzodiazepines, often referred to as “benzos,” are prescription sedatives commonly used to manage anxiety and insomnia. They work by increasing the levels of GABA, an inhibitory neurotransmitter, in the brain, resulting in a calming and sedative effect. Common examples of benzodiazepines include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin).
It’s important to clarify whether benzos are narcotics. While the term “narcotics” is sometimes used broadly, in a precise pharmacological and legal context, it typically refers to opioids and certain other controlled substances that induce sleep and relieve pain. Benzodiazepines are classified as CNS depressants, not narcotics, although they are also controlled substances due to their potential for misuse and dependence. Despite not being narcotics, benzodiazepines carry significant risks, especially when combined with opioids. Researchers have also detected benzodiazepines in the illicit opioid supply, indicating a potential for unintentional combined use.
The Heightened Risk of Mixing Benzos and Opioids
Every day, approximately 220 Americans succumb to opioid overdoses. Combining opioids and benzodiazepines intensifies overdose risk because both drug types can cause pronounced sedation and respiratory depression—the primary cause of overdose fatalities. Furthermore, this combination impairs cognitive functions. Studies indicate that individuals using both opioids and benzodiazepines concurrently face a significantly increased risk of emergency department visits, hospital admissions for drug-related emergencies, and fatal overdoses.
For instance, a study conducted 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. Similarly, research involving U.S. veterans with opioid prescriptions found that benzodiazepine prescriptions were linked to an elevated risk of drug overdose death, with the risk increasing with higher benzodiazepine doses.
The Centers for Disease Control and Prevention (CDC) provides clear guidance in their Clinical Practice Guideline for Prescribing Opioids for Pain, urging clinicians to exercise extreme caution when prescribing benzodiazepines alongside opioids and to carefully weigh the benefits against the risks. Both prescription opioids and benzodiazepines now feature U.S. Food and Drug Administration boxed warnings on their packaging, underscoring the serious dangers of their combined use.
It is vital for anyone prescribed medication to inform their healthcare provider about all other substances and medications they are using. Consulting with healthcare professionals about the risks associated with combining medications and substances is essential for managing and mitigating potential dangers.
