Taking opioids with central nervous system depressants, such as benzodiazepines like Xanax, significantly elevates the risk of a life-threatening overdose. It’s crucial to understand the dangers of polysubstance use, especially the combination of opioids and benzodiazepines.
In 2021, approximately 14% of opioid overdose fatalities also involved benzodiazepines. Benzodiazepines, often called “benzos,” are prescription sedatives commonly used to treat anxiety and insomnia. These medications work by increasing the level of GABA, an inhibitory neurotransmitter, in the brain, leading to a calming or sedative effect. Commonly prescribed benzodiazepines include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin).
Alarmingly, benzodiazepines have been detected in the illegal opioid supply in certain areas. This suggests that individuals might be unknowingly or knowingly consuming benzodiazepines alongside illicit opioids, further compounding the risks.
The Dangers of Co-Prescribing Opioids and Benzodiazepines
Every day, around 220 Americans succumb to opioid overdoses. Combining opioids and benzodiazepines dramatically increases the overdose risk because both drug types can cause sedation and respiratory depression, which is the primary cause of overdose deaths. Furthermore, this combination impairs cognitive functions, making it even more dangerous. Research indicates that individuals who concurrently use opioids and benzodiazepines face a heightened risk of emergency room visits, hospital admissions for drug-related emergencies, and fatal drug 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, a study focusing on U.S. veterans with opioid prescriptions found a dose-dependent increase in the risk of drug overdose death associated with benzodiazepine prescriptions.
The Centers for Disease Control and Prevention (CDC) emphasizes caution in their Clinical Practice Guideline for Prescribing Opioids for Pain. They recommend that healthcare providers carefully weigh the benefits against the risks when considering prescribing benzodiazepines alongside opioids. Both prescription opioids and benzodiazepines now carry U.S. Food and Drug Administration “boxed warnings” on their labels, the strongest warning type, highlighting the significant dangers of using these drugs in combination.
It is crucial for individuals prescribed any medication to inform their healthcare providers about all other substances and medications they are using. Open communication with healthcare teams is essential to mitigate and manage the risks associated with combining certain medications and substances.
References
[1] National Institute on Drug Abuse. (2023, March 21). Overdose Death Rates. National Institutes of Health. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
[2] Centers for Disease Control and Prevention. (2023, March 24). Polysubstance Use. National Center for Injury Prevention and Control, Division of Overdose Prevention. https://www.cdc.gov/stop-overdose/caring/polysubstance-use.html
[3] National Institute on Drug Abuse. (2023, August 9). Benzodiazepines and Opioids. National Institutes of Health. https://nida.nih.gov/drug-topics/opioids/benzodiazepines-opioids
[4] Park, T. W., Saitz, R., Ganoczy, D., Ilgen, M. A., & Bohnert, A. S. B. (2015). Benzodiazepine Use, Opioid Use, and Risk of Overdose. The American Journal of Psychiatry, 172(12), 1216–1223.
[5] Gomes, T., Juurlink, D. N., Dhalla, I. A., Mailis-Gagnon, A., Paterson, J. M., & Mamdani, M. M. (2011). Co-prescribing of opioid analgesics and benzodiazepines and risk of adverse outcomes. CMAJ : Canadian Medical Association Journal, 183(18), 1963–1971.
[6] Dasgupta, N., Beletsky, L., Ciccarone, D. (2016). Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. American Journal of Public Health, 108(2), 182-186.
[7] Bohnert, A.S.B., Ilgen, M.A., Gefeller, O., Valenstein, M., Melfi, C.A., Etransi, K.R., Ganozy, D., Blow, F.C. (2011). Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths. JAMA, 305(13), 1315–1321.
[8] Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR. Recommendations and Reports, 71(No. RR-3), 1–95.
