Polysubstance Abuse: Benzodiazepines and Opioids

Benzodiazepines and opioids are often used together, especially with the number of people who are prescribed anxiety pills annually. Over 30 million people take benzos annually, and 5.3% of those people say they misuse them.

Benzodiazepines, a class of prescription medications commonly used to treat anxiety, insomnia, and certain medical conditions, can be especially dangerous when used in combination with opioids. Yet many people are not aware of the dangers and may take them both together. People who misuse them may do so for enhanced relaxation and fewer inhibitions. Misusing benzos alone is dangerous, but when taken alongside opioids, there is a high risk of overdose.

Both young and older adults may have substance use disorder. They may be taking substances prescribed by doctors or they may get them through illicit means, such as online markets or on the street. These illicit markets often have tainted drugs; a person thinks they are buying Oxycontin or Xanax but instead ends up with fentanyl, known for fatal accidental overdoses. Some drugs are much more potent on the street, making it difficult to know if there is overdose potential. Many people who take benzodiazepines and opioids know nothing of the hazards or dangers.

Understanding Polysubstance Use

Many people who use drugs recreationally or for certain medical conditions may use more than one drug together to enhance the effects. Both benzodiazepines and opioids are psychoactive substances that can have sedative effects on the central nervous system and when used together, but they also pose significant risks.

Benzodiazepines, such as diazepam or alprazolam, are commonly prescribed for anxiety, insomnia, and certain medical conditions. They enhance the effect of a neurotransmitter called gamma-aminobutyric acid (GABA). This is what leads to sedation and relaxation. Opioids, on the other hand, are prescribed for pain management and can produce feelings of euphoria when they bind to opioid receptors in the brain. Together, these drugs magnify each other's depressant effects on the central nervous system, increasing the risk of respiratory depression, sedation, and overdose.

Legally, both benzodiazepines and opioids can be prescribed by healthcare professionals for legitimate medical reasons. However, anyone has the potential to misuse them. When taken outside of prescribed guidelines or obtained illicitly, individuals may misuse these drugs and end up with a much stronger reaction to their effects.

The combination of benzodiazepines and opioids is particularly dangerous. People who do this seek to intensify the sedative and euphoric effects. However, if they misjudge their dosage or tolerance, this leads to a higher risk of adverse outcomes, including overdose and death.

People misuse benzodiazepines and opioids for many reasons. They may be seeking escape from emotional pain, self-medicating, or simply chasing a more potent high. Addressing polysubstance use requires comprehensive interventions that consider the underlying factors contributing to substance abuse. People who stop using drugs need support and education to make better choices and learn coping skills.

Dangers of Benzodiazepines and Opioids

Using benzodiazepines and opioids together can pose several serious risks due to their overlapping effects on the central nervous system and respiratory function, as well as:

• Respiratory Depression: Both are central nervous system depressants, which means they slow down brain activity and can lead to respiratory depression. When used together, their combined depressant effects can be synergistic, significantly impairing an individual's ability to breathe. This can lead to life-threatening respiratory failure, especially in cases of high or prolonged doses or when mixed with other substances like alcohol.
• Increased Sedation: Benzodiazepines are known for their sedative properties, and when used alongside opioids, the sedation effect is magnified. This increased drowsiness can lead to accidents and falls.
• Effects on Cognitive Function: Opioids and benzodiazepines can impair cognitive and motor skills, and their combination can lead to impaired judgment and coordination. This can be dangerous when individuals engage in activities such as driving or operating heavy machinery while under the influence of these substances.
• Risk of Overdose: The combined use of these drugs significantly increases the risk of overdose. Opioid overdose reversal drug naloxone (Narcan) may be less effective in cases of mixed opioid and benzodiazepine overdose, as it can't fully counteract the effects of benzodiazepines.
• Tolerance and Dependency: Concurrent use of opioids and benzodiazepines can increase the risk of developing tolerance and physical dependency on both classes of drugs. This can lead to a more challenging and dangerous cycle of addiction and withdrawal.
• Withdrawal Complications: When individuals who have been using both opioids and benzodiazepines decide to stop, they may experience severe withdrawal symptoms, including anxiety, tremors, seizures, and other complications. Medically supervised detox and withdrawal management may be required.

Using benzodiazepines and opioids can be dangerous and often signals more issues need to be addressed. People who use these drugs together and misuse them usually have symptoms of a substance use disorder. Getting medical help for detox can be the first step to reclaiming your life.

Getting Help for Addiction

If you or somebody you love is struggling with polysubstance use or other substance use disorders, we’re here to help. Get in touch to learn more about how we can help.