Opioids and Benzodiazepines: Why These Medications Don’t Mix
Key takeaways:
Opioids are medications used to treat moderate to severe pain. Benzodiazepines are prescribed for conditions like anxiety, panic disorder, and insomnia (sleeping problems).
Taken on their own, both opioids and benzodiazepines can cause drowsiness, misuse, and overdose. When combined, these risks are even greater.
In most cases, it’s best to avoid taking opioids and benzodiazepines together.
Table of contents
Opioids and benzodiazepines are two groups of prescription medications. They treat different conditions and work in different ways. But they also have some similarities, especially when it comes to their risks. And this is the main reason these medication groups don’t mix.
Here, we’ll cover a few reasons why taking opioids and benzodiazepines at the same time isn’t a good idea.
Why should you avoid taking opioids and benzodiazepines together?
It’s best to avoid combining opioids and benzodiazepines because of the increased risk of harmful side effects, including overdose and death.
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Opioids are prescribed to treat moderate to severe pain when non-opioid pain medications haven’t worked. Examples of opioids include oxycodone (Roxicodone, Oxycontin), tramadol (Ultram, Conzip), and hydrocodone / acetaminophen.
Benzodiazepines are prescribed to treat several health conditions, including anxiety, panic disorder, and insomnia (sleeping problems). Examples of benzodiazepines include alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium).
Both groups of medications can be taken safely under the guidance of a trained healthcare professional. But they both have several risks to know about. And the FDA and other health experts recommend against combining opioids and benzodiazepines in most cases.
The major risks of combining these medications include drowsiness and dizziness, misuse, and overdose. We’ll cover each of these risks in detail below.
Drowsiness and dizziness
Opioid side effects and benzodiazepine side effects often overlap. This means that certain side effects, like drowsiness and dizziness, can be worse when these medication groups are combined. Increased drowsiness and dizziness from this combination can also increase your risk of falls, injuries, and hospital admissions.
Falls are particularly risky for older adults. And they can have lasting negative impacts on mobility and health. This is one reason opioids and benzodiazepines aren’t usually recommendedfor people over 65.
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Misuse
Individually, opioids and benzodiazepines can both cause dependence and misuse. This is why they’re both classified as controlled substances by the Drug Enforcement Administration (DEA). And research shows that misusing one medication group increases your risk of misusing the other.
Keep in mind that dependence and misuse aren’t the same thing. Simply put, dependence is when your body relies on a medication to function normally. Dependence can happen even if you take an opioid or benzodiazepine exactly as prescribed. But misuse occurs if you take one of these medications in a way that’s different from how it’s prescribed or when it’s not prescribed to you.
Misuse can lead to a substance use disorder. This is a condition in which you use a substance despite the significant problems it’s causing in your life. These problems may include worsening health and relationship issues at work, home, or school.
Symptoms of substance use disorder include taking more of a medication than what’s prescribed and failing to meet responsibilities at home or work due to substance use. If you experience these symptoms, talk to your prescriber immediately. They can help determine whether you’re experiencing substance use disorder and connect you with treatment options.
If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.
Overdose
Perhaps the most serious risk of taking opioids and benzodiazepines together is overdose. And while it’s possible to overdose on an opioid or benzodiazepine alone, combining the two medications increases your risk. In fact, up to 50% of opioid overdose deaths also involve benzodiazepines.
All opioids and benzodiazepines carry a boxed warning about the risk of overdose when these medications are combined. A boxed warning is the most serious warning the FDA can assign a medication.
Symptoms of an opioid overdose or benzodiazepine overdose include slow, shallow, or irregular breathing. Pale and clammy skin, or unconsciousness, may also occur. If you think you’re witnessing an overdose, call 911. Then, administer naloxone (Narcan, Zimhi) if you have it.
Naloxone is a lifesaving medication that can quickly reverse the effects of an opioid overdose. In fact, it’s a good idea to carry naloxone on you at all times if you or someone in your household takes opioids. You can get it with or without a prescription. It’s even available over the counter.
Good to know: Naloxone isn’t a substitute for medical attention because it only lasts for a short period. But it can buy you time until emergency responders arrive. Naloxone also won’t reverse an overdose that only involves benzodiazepines. However, it’s still a good idea to administer naloxone even if you’re not sure whether an overdose involves opioids. Administering naloxone won’t cause harm, even if opioids aren’t involved.
A word on opioids, benzodiazepines, and alcohol
It’s important to avoid drinking alcohol if you take opioids and/or benzodiazepines.
Drinking alcohol while taking opioids or benzodiazepines increases your risk of an overdose. Alcohol can also make the effects of opioids and benzodiazepines more unpredictable and stronger.
If you’ve prescribed a benzodiazepine or opioid and you’re not sure you can avoid drinking, have an honest discussion with your prescriber. They may be able to recommend a medication that doesn’t interact with alcohol. They can also evaluate you for alcohol use disorder and provide you with resources and treatment options, if needed. Even if you just want help cutting back on alcohol use, they can help you navigate your options.
What are some alternatives to opioids and benzodiazepines?
Research shows that chronic pain and anxiety may work hand in hand for some people. So it’s possible that you may need medication for chronic pain and anxiety. We’ve discussed why taking opioids and benzodiazepines together isn’t a good idea. But even taking these medications alone isn’t always the best option.
Opioids aren’t first-choice medications for chronic pain. And benzodiazepines aren’t first-choice medications for anxiety or the other conditions they're prescribed for, such as insomnia.
Opioids are usually only prescribed if non-opioid medications don’t work for chronic pain. So there are several treatment options for pain beyond opioids. Some examples include:
Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin)
Topical NSAIDs like diclofenac gel (Voltaren Arthritis Pain Gel)
Acetaminophen (Tylenol)
There are also non-medication treatment options that may help, like talk therapy, physical therapy, and transcutaneous electrical nerve stimulation (TENS).
For anxiety, medications that are often tried before benzodiazepines include:
Selective serotonin reuptake inhibitors (SSRIs), such as escitalopram (Lexapro)
Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor XR)
Buspirone
Therapy, especially cognitive behavioral therapy (CBT), is also incredibly helpful for treating anxiety.
Additionally, medical cannabis or CBD may be an option for treating chronic pain or anxiety. But you should only try medical cannabis under the guidance of a trained medical professional. Medical cannabis can worsen pain and anxiety symptoms if it isn't taken at the correct dosage. It also has its own side effects and drug interactions to be aware of, and isn’t recommended if you have a history of substance misuse. If your medical professional recommends cannabis for pain or anxiety, only purchase it from licensed dispensaries to avoid possible contaminants.
The bottom line
Opioids and benzodiazepines have legitimate medical uses, but they also carry several risks. When combined, these risks are even greater. This includes worsening side effects, such as drowsiness and dizziness. It also includes a higher chance of dependence, misuse, and overdose.
If you take either type of medication, you can minimize your risks by taking them exactly as prescribed for the shortest amount of time possible. It’s also best to avoid alcohol while you’re taking them. And in most cases, it’s best to avoid taking opioids and benzodiazepines together.
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References
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