The Risks Associated With Combining Benzodiazepines and Opioids

Patient Expert

The sedative effect of benzodiazepines such as diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan) can be used to treat insomnia as well as panic and anxiety disorders. One study found that as many as 42 percent of new benzodiazepine prescriptions issued to older adults were for insomnia and 36 percent were for anxiety.

Although nonbenzodiazepines such as zolpidem (Ambien and other brands) are becoming more popular than benzodiazepines, a significant number of those who struggle with sleep issues are still being prescribed the latter form of medication.

The sleep/pain connection

In the United States, as many as 20 percent of individuals who report non-cancer pain symptoms or a diagnosis of acute or chronic pain receive an opioid prescription.

Insomnia has been found to make individuals more sensitive to pain, and those suffering from pain (such as back pain) may find it more difficult to fall asleep and stay asleep.

A study published in 2017 set out to determine the effect that taking benzodiazepines at the same time as opioids had on hospital admissions and emergency room visits.

The risks of taking opioids and benzodiazepines together

Researchers found that between 2001 and 2013 there was an 80 percent increase in the number of people taking opioids and benzodiazepines concurrently.

After examining data collected from over 300,000 individuals between the ages of 18 and 64, the study found that those who took both drugs were more than twice as likely to visit an emergency room or be admitted as an inpatient for opioid overdose.

Researchers suggested that eliminating concurrent use of benzodiazepines and opioids could reduce the risk of an emergency room visit or inpatient admission for opioid overdose by 15 percent.

The pros and cons of benzodiazepines

The authors of a 2015 study published by the American Medical Association pointed out that benzodiazepines have been found to be more effective than placebos for controlling a range of anxiety symptoms and for reducing how long it takes to fall asleep. Separate studies have suggested that benzodiazepines can also increase total sleep duration, probably due to the longer half-lives of these drugs.

With that being said, researchers pointed out that this class of drug has been linked to withdrawal symptoms and abuse, and can pose serious cognitive risks and an increased risk of falls among older individuals.

The pros and cons of opioids

In 2016, the United States Centers for Disease Control and Prevention (CDC) stated that evidence supported the effectiveness of opioids at reducing chronic pain in the short-term. However, there is scant evidence to suggest opioids are an effective long-term treatment option for chronic pain.

As pointed out by the CDC, opioids come with serious risks such as overdose and opioid use disorder. They can also weaken the respiratory system, making the urge to breathe less powerful. This could explain why one study found as many as 85 percent of those taking opioids suffered from some form of sleep apnea.

What to do if you’re taking benzodiazepines and opioids

The Centers for Disease Control and Prevention (CDC) stated that clinicians should avoid prescribing benzodiazepines and opioids at the same time whenever possible. With that being said, the CDC pointed out that for those who are taking both drugs, tapering off opioids first may be safer and more practical.

The CDC also noted that if benzodiazepines prescribed for anxiety are tapered or discontinued, or if those taking opioids require treatment for anxiety, cognitive behavioral therapy should be offered.

Speak with your doctor

You should not make any changes to your medication regimen without speaking with your doctor first. If you have any concerns about your health or the medication you are taking, discuss them with your doctor.

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