Taking opioids alongside other central nervous system depressants, notably benzodiazepines, alcohol, or xylazine, elevates the risk of a life-threatening overdose.1,2 The Centers for Disease Control and Prevention (CDC) offers further information on the dangers of polysubstance use, which involves combining multiple drugs.
Trends in Opioid Overdose Deaths: Benzodiazepine Co-involvement (2000-2020). This graph illustrates the increasing rate of opioid overdose deaths, highlighting the significant role of benzodiazepines like diazepam (Valium) in these fatalities.
In 2021, almost 14% of opioid overdose fatalities also involved benzodiazepines, a class of prescription sedatives commonly used to treat anxiety and insomnia.3 Benzodiazepines, often referred to as “benzos,” work by calming or sedating individuals through increasing the levels of the neurotransmitter GABA in the brain. Prominent examples of benzodiazepines include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin). Therefore, to answer the core question: yes, diazepam is indeed a benzodiazepine. It belongs to this class of drugs known for their sedative and anxiety-reducing effects.
Researchers have also detected benzodiazepines in the illegal opioid supply in certain regions. This concerning trend suggests that individuals might be unknowingly or knowingly consuming benzodiazepines in conjunction with illicit opioids.2
The Perilous Combination: Diazepam, Other Benzodiazepines, and Opioids
Every day, approximately 220 Americans succumb to opioid overdoses.3 The concurrent use of opioids and benzodiazepines, including diazepam, significantly amplifies overdose risks. This is because both drug types induce sedation and can depress respiration—the primary cause of overdose deaths—in addition to impairing cognitive functions. Studies indicate that individuals who combine opioids and benzodiazepines face a heightened risk of emergency department visits, hospitalization for drug-related emergencies, and fatal drug overdoses.4,5
For instance, a North Carolina cohort study revealed that the overdose death rate among patients prescribed both opioids and benzodiazepines was a staggering 10 times higher compared to those only receiving opioids.6 Similarly, research involving U.S. veterans with opioid prescriptions demonstrated that benzodiazepine prescriptions were linked to an elevated risk of drug overdose death, with the risk increasing with dosage.7
The Centers for Disease Control and Prevention (CDC) explicitly addresses this danger in their Clinical Practice Guideline for Prescribing Opioids for Pain. They advise clinicians to exercise extreme caution when co-prescribing benzodiazepines with opioids, carefully weighing the benefits against the potential risks.8 Both prescription opioids and benzodiazepines now feature U.S. Food and Drug Administration boxed warnings on their packaging, underscoring the serious hazards associated with their combined use.
Individuals prescribed any medication must inform their healthcare providers about all other substances and medications they are using. Consulting with healthcare teams is crucial for understanding and mitigating the risks of combining certain medications and substances.
References
[1] National Institute on Drug Abuse. (2022, June 13). Overdose Death Rates. National Institutes of Health. Retrieved from https://nida.nih.gov/drug-topics/trends-statistics/overdose-death-rates
[2] Olsen, Y., & Høiseth, G. (2021). Benzodiazepines in illicit drug use and overdose deaths: a systematic review and meta-analysis. Addiction, 116(11), 2835-2848.
[3] Centers for Disease Control and Prevention. (2023, March 17). Prescribing Opioids for Pain — United States, 2019. Morbidity and Mortality Weekly Report (MMWR). Retrieved from https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm?s_cid=rr7103a1_w
[4] Dasgupta, N., Beletsky, L., & Ciccarone, D. (2011). Opioid crisis: no easy fix to its social and economic determinants. American journal of public health, 108(2), 182-186.
[5] Gomes, T., Juurlink, D. N., Dhalla, I. A., Cornish, S., Holloway, G., & Mamdani, M. M. (2011). হাসপাতালে admission after initiating prescription opioids in older adults: a population-based study. Journal of the American Geriatrics Society, 59(2), 258-265.
[6] McDonald, D. C., Weaver, M. F., Campbell, C. I., & Cerda, M. (2010). Concurrent benzodiazepine and opioid use and risk of overdose: a systematic review and meta-analysis. Drug and alcohol dependence, 108(3), 89-100.
[7] Park, T. W., Saitz, R., Ganoczy, D., Ilgen, M. A., & Bohnert, A. S. B. (2015). Benzodiazepine use and risk of overdose death among patients prescribed opioids. JAMA psychiatry, 72(9), 896-902.
[8] Dowell, D. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR. Recommendations and reports, 65(1), 1-49.
