Dangerous Duo: Understanding Risks Associated with Concurrent Opioid and Benzodiazepine Use

Jody Gembarski

| 3 min read

Clinical Manager of Pharmacy Services at Blue Cross

Image of doctors and a nurse wheeling a patient on a gurney.
While benzodiazepines have received less public attention than opioids over the past year, it’s estimated that nearly 30 percent of fatal opioid overdoses also involved benzodiazepines. According to the Food and Drug Administration, combined use of these two medications increased by 41 percent between 2002 and 2014. Benzodiazepines are a class of medications that work in the central nervous system to treat a variety of conditions, including anxiety (short-term use), panic disorders, alcohol withdrawal and seizures. Well-known “benzos”, as they’re sometimes called, include Xanax®, Klonopin® and Valium®. Benzodiazepines may be co-prescribed with opioids due to their anxiety-reducing and skeletal muscle relaxant effects, but combining these medications can be dangerous. Benzodiazepines intensify the respiratory depressant effects of opioids, which means breathing can be slowed down or stopped altogether. This drug class also carries similar risks of tolerance and dependence that opioids have. Another concern is that benzodiazepines can enhance the euphoric effects of opioids, making them a prime candidate for misuse or abuse.
When benzodiazepines are combined with opioids, it nearly quadruples the risk of an overdose-related death compared to opioid use alone.
Due to the rise in prevalence and potentially fatal consequences of concurrent use, the FDA and Centers for Disease Control and Prevention have taken firm action. Both drug classes now carry “boxed warnings” and revisions to labeling to caution patients and providers about the concurrent use of these medications, which may result in extreme sedation, respiratory depression, coma and death. The CDC recommends clinicians avoid prescribing opioids and benzodiazepines concurrently whenever possible. Patients suffering from anxiety may be prescribed benzodiazepines due to their fast-acting sedative effects. However, clinical guidelines recommend against their use for treatment of generalized anxiety disorder except in limited circumstances on a short-term basis. Antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), are first-line treatments when medications are needed for anxiety.

For physicians

If benzodiazepines are co-prescribed with opioids, limit dosages and durations to the minimum required, monitor patients for signs and symptoms of respiratory depression and extreme sedation, and provide education about the increased risks of overdose, death and addiction. If you have questions or need additional information, email RxOpioidTaskForce@bcbsm.com.

For patients

It’s important to let your primary care physician know about all the medications you’ve been prescribed and that you’re currently taking. If your doctor wants to prescribe benzodiazepines in addition to opioids you’re already taking, or vice versa, talk to them about the risks and work together to come up with an action plan you and they are comfortable with. Sources: CDC Morbidity and Mortality Report FDA Drug Safety Communication If you enjoyed this post, you might also like:
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Dec 31, 2018 at 9:32pm

I will leave a comment. I have severe anxiety, anxiety doesn't just last for a few weeks, it can be an every day pain the butt. No one wants to feel like they are dying and they go to the ER only to told it's anxiety and then you get treated like a total piece of crap cause you took up time that could have been given to others.. This has happened to me several times. Symptoms I have had....are irregular heart beat, sweating, diarrhea, my eyes wouldn't focus, I was stumbling around, I was vomiting.. I went to the hospital I was treated like a total pain the neck. my sodium was low, how did I know and my anxiety kicked in thinking I was having a heart attack.. my doctor has dropped my Xanax from 1 mg to .05 with a dispense of 20 pills with no refills. My problem with this is people who do not use this drug responsibly as in Drug Addicts they will get this medication one way or another they will find it, and they are still overdosing, now they are producing more powerful opioids and adding to the problem these drug companies. I use responsibly, I have ridiculed so much for going into the ER I refuse to go anymore, so will the next time I have these anxiety attacks and I just stay home concentrating on my breathing and I do have a heart attack, is that of no concern ? Drug addicts will get drugs no matter what type of ban you put on them, they will still get them, Maybe there should be more help for the addicted that use for the fun of it and to get high, rather than punish the ones who use it as prescribed.

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