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Opioids and Benzodiazepines: Can You Mix Them Safely?

Benzodiazepines are common prescription remedies for a variety of issues like insomnia, anxiety, and seizures. If you’re given any prescription medication, it’s your responsibility to learn how to take it safely and to be aware of any potentially harmful interactions with other substances. Though the opioids represent a significant risk in the current addiction epidemic, prescription drugs like benzodiazepines should be taken seriously. Benzos, like other prescriptions, can be potentially dangerous when they are mixed with other medications. The National Institute on Drug Abuse reports that more than 30 percent of opioid overdoses also involve benzodiazepines. Together, opioid and benzos can cause dangerous and potential side effects, especially when one or both of them are taken without a prescription.

But what if you are taking a benzodiazepine to treat a sleep disorder and you are going through treatment or procedure that can be aided with opioids. Does taking one of these drugs disqualify you from being treated with the other? In some cases, people with substance use disorders are treated with opioids in medication-assisted treatment programs. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), more than 21 million people had substance use disorders in 2014. At the same time, one in four people struggles with insomnia. In many cases, these disorders can overlap making it more likely for benzos and opioids to be mixed.

However, benzos are sometimes used for recreational purposes. As a central nervous system depressant, taking enough of benzo will cause alcohol-like intoxication. These effects may be even more intense when opioids are used at the same time. But mixing the two drugs can be deadly, but taking prescription benzos doesn’t necessarily disqualify you from being treated with opioids. Learn more about these two drugs and why mixing them can be dangerous.

Why Opioids and Benzos are Dangerous Together?

Benzodiazepines are in a class of drugs called central nervous system depressants that work in the brain to limit the excitability of your nervous system. Benzos share this category with barbiturates, other prescription sleep aids, and alcohol. Benzos work in the brain by affecting a naturally occurring chemical called gamma-aminobutyric acid (GABA). Benzos bind to GABA receptors in the brain and increase the efficiency of GABA. Since GABA is responsible for regulating excitability in the central nervous system, benzos increased its normal effects, leading to sedation, hypnosis, and anxiolysis (anti-anxiety). Heavy doses of benzos can cause symptoms that are similar to alcohol intoxication like dizziness, loss of motor control, depression, confusion, and memory impairment.

Opioids are in a separate category, but they also cause some depressing effects. Opioids are chemical substances that are similar to your body’s endorphins, which help manage pain by blocking pain signals and promote rest and recovery. Opioids bind to the same receptors as endorphins, but they are often much more potent than your body’s own brand. Opioids can cause sedation, pain relief, and a feeling of euphoria.

Very heavy doses of both drugs can slow your nervous system down to the point of impeding important functions. Opioids like heroin can cause potentially fatal overdoses fairly easily, if you aren’t careful about the dose you’re taking or if you aren’t sure how pure it is. Benzos are most commonly obtained in prescriptions, and normal doses are less likely to lead to a fatal overdose. However, very high doses can be deadly. But, when the two drugs are combined, it significantly raises the threat of an overdose because of a phenomenon called potentization.

Drugs potentiate each other when they share some of the same effects in the brain or body.

When they are combined, they work together to compound their effectiveness, causing more intense effects in smaller doses. If you take a normal dose of a benzo and an opioid, you may experience the same adverse reaction that you would if you had taken a high dose of either one separately. A benzo/opioid overdose becomes deadly when your breathing is slowed or stopped. Your nervous system becomes so sluggish that it no longer efficiently regulates your breathing. You may experience a loss of consciousness, oxygen deprivation, brain damage, coma, or death. Mixing these drugs can produce these symptoms when you don’t expect them. Because of their potentiating effects, you may become more intoxicated than you would expect. Fortunately, opioid overdoses can be reversed with a medication called naloxone, and it can help during cases where opioids and benzos are mixed.

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Using Opioids and Benzodiazepines Safely

Both benzodiazepines and opioids can lead to physical dependence and addiction if they are abused or used consistently for a long time. Benzos are generally used for short term therapeutic treatment of sleep and anxiety disorder. Using them for several months at a time can lead to dependence. Opioids are sometimes used for long-periods to treat chronic pain, but they can also lead to dependence. When used as directed by a doctor or pharmacist, you are much less likely to experience dependence, addiction, or dangerous side effects. However, you should always monitor yourself when you’re taking new medications or changing your dose. If you feel like a drug is becoming less effective, or if you feel uncomfortable symptoms, notify your doctor.

Using benzodiazepines and opioids at the same time should generally be avoided, but in some cases, it might be necessary. Still, if you’re taking an opioid and your doctor prescribes benzo, double-check to make sure the two are safe to mix. Medical professionals aren’t infallible, and it’s always good to ask questions when it comes to your treatment and health care.

When it comes to people who have both a substance use disorder and a disorder that is being treated with benzos, experts warn against ruling out MAT as an option. People who are seeking addiction treatment for opioid addictions while also taking benzos may make clinicians think twice before prescribing opioid medications. But the U.S. Food and Drug Administration says that medications shouldn’t necessarily be withheld from clients who take benzos. In a 2017 safety announcement they said, “The combined use of these drugs increases the risk of serious side effects; however, the harm caused by untreated opioid addiction can outweigh these risks.”

Though mixing the two medications comes with significant risk, it can be done safely in some situations with the help of a professional. Still, increasing your dose or mixing the drug on your own can be dangerous. Always ask your doctor before changing the size or frequency of a dose of prescription medication and if you experience new symptoms or side effects.

Sources

Lipari, R. N., Ph.D., & Van Horn, S. L., M.A. (2017, June 29). TRENDS IN SUBSTANCE USE DISORDERS AMONG ADULTS AGED 18 OR OLDER. Retrieved from https://www.samhsa.gov/data/sites/default/files/report_2790/ShortReport-2790.html

National Institute on Drug Abuse. (2018, March 15). Benzodiazepines and Opioids. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids

SAMHSA. (2015, July 21). Medication-Assisted Treatment (MAT). Retrieved from https://www.samhsa.gov/medication-assisted-treatment

WebMD. (n.d.). Gaba (Gamma-Aminobutyric Acid): Uses, Side Effects, Interactions, Dosage, and Warning. Retrieved from https://www.webmd.com/vitamins/ai/ingredientmono-464/gaba-gamma-aminobutyric-acid

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