Mixing Benzodiazepines and Opioids: Effects & Dangers of Misuse

Benzodiazepine misuse rarely occurs alone.¹ Around 80% of cases involve polysubstance misuse, most commonly with opioids.¹ Polysubstance use involving benzodiazepines and opioids is dangerous and can lead to severe adverse health effects.² People may combine these substances intentionally or unintentionally, but all instances of this combination can increase the risk of life-threatening overdose.^2,3

What Are Benzodiazepines and Opioids?

Benzodiazepines are a class of prescription drugs that function as central nervous system (CNS) depressants.⁵ They may be prescribed to treat various conditions, including anxiety and sleep disorders.⁵ Common benzodiazepines include:⁶

• Alprazolam (Xanax).
• Clonazepam (Klonopin).
• Diazepam (Valium).
• Lorazepam (Ativan).
• Triazolam (Halcion).

As mentioned, benzodiazepines are not typically a person’s primary substance of misuse; misuse most commonly occurs in conjunction with other substances, including alcohol and opioids.⁷

Opioids include illicit drugs like heroin, as well as prescription opioids that may be prescribed to treat moderate to severe pain.⁸ Heroin and prescription opioids are chemically similar, but their effects differ based on their pharmacological properties, method of administration, and impact on brain activity.^8,9 Common prescription opioids include:⁸

• Hydrocodone (Vicodin).
• Oxycodone (Oxycontin, Percocet).
• Morphine (Avinza, Kadian).
• Codeine.
• Fentanyl.

While fentanyl is a prescription drug that is often prescribed to treat severe pain, it is also made and used illegally.¹⁰ It is similar to morphine, but up to 100 times more potent and frequently mixed with other drugs like cocaine, heroin, and meth, sometimes unbeknownst to the user.¹⁰ Synthetic opioids like fentanyl are the most common drugs involved in overdose deaths.¹⁰

Why Do People Mix Benzodiazepines and Opioids?

People may combine substances, such as benzodiazepines and opioids, intentionally for various reasons, including to:^1,3

• Alter or enhance the effects of a substance.
• Compensate for the effects of a substance.
• Avoid withdrawal symptoms.
• Escape reality due to health problems, life circumstances, or trauma.

They may also combine them unintentionally, which can occur when a person unknowingly consumes a substance due to unintentional exposure.^2,11 This is particularly dangerous for individuals using illicit opioids like fentanyl or heroin or purchasing counterfeit prescription pills. Many counterfeit prescription pills are made to look like legitimate benzodiazepines or opioid pain relievers but may contain unknown substances, including fentanyl. This significantly increases the risk of overdose, especially when combined with benzodiazepines.^3,11

What Are the Dangers of Mixing Benzodiazepines and Opioids?

Mixing benzodiazepines and opioids is extremely dangerous and can lead to serious health effects.^2,3 Both substances are central nervous system (CNS) depressants, meaning they can cause sedation and suppress breathing.² This synergistic effect can lead to oversedation and dangerously suppressed breathing and heart rate, resulting in permanent brain injury, overdose, or death.^2,3,7

The combined effects of benzodiazepines and opioids also impair cognitive functioning, which can affect a person’s judgment, decision-making, and reaction time and may increase the likelihood of accidental overdose and other dangerous behaviors.²

Studies show that mixing benzodiazepines with prescription opioids greatly increases the risk of severe emergency department outcomes.^2,12 Older adults face an even higher chance of serious consequences.¹²

Individuals who use benzodiazepines and opioids should know that they both carry U.S. Food and Drug Administration (FDA) boxed warnings on their labels that highlight the potential dangers of using these drugs together.²

Overdose from benzodiazepines and opioids mixed can result in serious symptoms such as:¹³

• Dizziness or lightheadedness.
• Extreme sleepiness.
• Difficulty breathing or slowed breathing.
• Unresponsiveness.

It’s important to note that the severity of the risks of combining these drugs depends on several factors, including the specific combination of drugs, the amount used, and the method of administration. As mentioned, prescription opioids and heroin have similar effects, but different risk factors.⁹ For example, heroin is often injected, which increases the risk of injection-related illnesses like hepatitis C and HIV.⁹

Benzodiazepine and Opioid Addiction

Once a person starts using multiple substances, it can be more difficult to stop than when a person only uses one substance.³ Both benzodiazepines and opioids can pose a risk for addiction, especially when used for longer periods.¹⁴ Addiction, which is diagnosed as a substance use disorder (SUD), is a condition that occurs due to brain changes associated with chronic use of a substance, resulting in compulsive drug seeking and use despite the negative consequences.¹⁴

Using multiple substances, including benzodiazepines and opioids, can increase a person’s risk of developing an SUD or multiple SUDs.³ Research on the effects of co-occurring SUDs is somewhat limited, but existing studies show that individuals with multiple SUDs face greater risks than those with a single SUD. Compared to people with only one SUD, those with concurrent SUDs are more likely to experience:³

• Higher rates of lifetime suicide attempts, arrests, and incarceration.
• Increased financial and legal difficulties.
• A greater risk of overdose.
• More severe medical and mental health conditions.

Treatment for Benzodiazepine and Opioid Addiction

No matter how things might seem right now, people who are addicted to benzodiazepines and/or opioids should know that treatment can help and recovery is possible. Evidence-based, individualized treatment can help people stop the problematic use of substances and enhance their quality of life.³

Treatment may begin with medical detox to help manage severe and potentially dangerous withdrawal symptoms as comfortably and safely as possible.¹⁵ Medical detox involves a set of interventions, such as medication, medical supervision, and support, designed to manage acute intoxication and withdrawal.¹⁵ It can also help address potential complications.¹⁵

Medical detox can be especially important for people who use benzodiazepines and/or opioids because of safety concerns, including serious withdrawal symptoms like seizures.¹⁵ People who complete detox are generally advised to transition to some type of formal treatment to help address the underlying causes of their substance misuse and learn the necessary skills to achieve and maintain recovery.¹⁵

Treatment can take place in different settings, such as:

• Inpatient drug and alcohol rehab, where people live onsite at a treatment facility and receive 24/7 care and support while participating in different types of therapies and treatments.¹⁶
• Outpatient addiction treatment programs, where people live at home but attend treatment at a rehab facility on a regular schedule.¹⁶
• Intensive outpatient addiction treatment programs, which are more supportive types of outpatient programs offering 9-20 hours of weekly treatment.¹⁶
• Partial hospitalization rehab programs, which are highly supportive outpatient programs offering 4-8 hours of daily treatment.¹⁶
• Sober living homes, which are drug- and alcohol-free residences that assist people in recovery while they transition back to their daily lives after rehab.¹⁶
• Rehab aftercare, which is a form of ongoing care that helps people maintain recovery and prevent relapse after they’ve completed a more formal treatment program.¹⁶ It can include interventions and supports such as 12-step groups, check-ins, or individual counseling.¹⁶

Although treatment looks different for everyone, it often involves a combination of interventions designed to help people achieve and maintain recovery, such as behavioral therapies (e.g., cognitive-behavioral therapy or contingency management), family therapy, FDA-approved medications, and support groups.^16,17

Start Your Recovery

If you or a loved one is ready to seek rehab for a substance use disorder, explore your options and reach out to a rehab center using our rehab directory tool today!