Dangers of Mixing Benzodiazepines and Opioids

Misusing benzodiazepines or opioids can be a very dangerous practice, especially when these drugs are used simultaneously.¹

This article will discuss why mixing benzos and opioids is dangerous, give the warning signs of an overdose from mixing benzos and painkillers, and explore treatment options for benzodiazepine and opioid misuse.

First, let’s go over what opioids and benzodiazepines are, and provide common examples of these prescription drugs.

Common Opioids and Benzodiazepines

Prescription opioids are medications that act on opioid receptors in the brain and are often used to treat acute or chronic pain.² In 2020, pharmacies across the United States dispensed approximately 143 million opioid prescriptions.³

Common opioids include:^1,2

• Oxycontin (oxycodone).
• Codeine.
• Fentanyl.
• Morphine.
• Vicodin (hydrocodone).

Benzodiazepines are central nervous system (CNS) depressants that work to calm an overly excited nervous system to help bring it to equilibrium. Depending on the specific medication, they may be prescribed to treat specific anxiety disorders such as panic disorder, acute stress, insomnia, and seizure disorders.² According to the U.S. Food and Drug Administration (FDA), there were 92 million benzodiazepine prescriptions dispensed in the United States in 2019.⁴

Common benzos include:^1,4

• Xanax (alprazolam).
• Ativan (lorazepam).
• Klonopin (clonazepam).
• Valium (diazepam).
• Serax (oxazepam).
• Restoril (temazepam).
• Librium (chlordiazepoxide).

 The top 3 prescribed benzos in 2019 were alprazolam (38%), clonazepam(24%), and lorazepam (20%).⁴

Why is it Dangerous to Mix Benzos and Opioids?

Mixing benzos and painkillers such as opioids is dangerous for several reasons, including the following:^5,6

• There is an increased risk of overdose because both benzos and opioids can cause sedation and suppress breathing—which is a common cause of overdose fatality.⁵
• Benzodiazepines and opioids can both cause impairments in cognitive functioning.⁵
• Combining benzodiazepines and opioids can lead to brain damage and damage to other organs.⁶

Research shows that there is a greatly increased risk of ER visits and hospital admissions due to drug-related emergencies, and fatal overdoses when opioids and benzos are combined.⁵ In 2020, 16% of overdose deaths involving opioids also involved benzodiazepines.⁵

Research shows that people who engage in polysubstance use—the use of more than one substance concurrently—involving CNS depressants tend to take higher doses of benzodiazepines, increasing the likelihood of the negative effects.⁷

Additionally, both benzodiazepines and opioids carry the potential for dependence and addiction, and polysubstance misuse can complicate the withdrawal process.⁸

Symptoms of An Overdose of Benzos & Opioids

Benzodiazepine overdose alone rarely results in a fatality; however, when combined with opioids, the risk of fatal overdose is very high.^5,9 One study showed that people who mixed benzos and opioids had a 10 times higher risk of overdose than those just prescribed opioids.⁵

Symptoms of opioid-involved overdose include:¹⁰

• Pale or clammy skin.
• Limp body.
• Blue or purplish fingernails or lips.
• Vomiting or gurgling noises.
• Slowed or stopped breathing.
• Weak pulse or stopped heartbeat.
• Inability to speak.
• Inability to be awakened.

An overdose is an emergency and requires immediate medical attention. If someone is overdosing, you should take immediate action and follow these steps:^6,10

• Call 911.
• Perform CPR if able to do so.
• Administer naloxone, if available.
• Try to keep the person awake and breathing.
• Lay the person on their side so they don’t choke.
• Remain with them until emergency help arrives.

Treatment for Benzodiazepine and Opioid Misuse

Addiction is a chronic, relapsing condition, but people can recover with proper treatment.¹¹

Treatment often begins with medical detox, as opioid withdrawal can be uncomfortable and benzo withdrawal can be dangerous.⁸

People who are dependent on benzodiazepines are often administered tapering doses of a long-acting benzo to reduce the risk of dangerous withdrawal symptoms.¹² Withdrawal medications and medications for opioid use disorder (MOUD) are commonly administered during detox to ease withdrawal symptoms and after detox to help people avoid relapse.^2,8,13

Most people with substance use disorders (SUDs)—the clinical term for addictions—benefit from continued treatment after detox. Research shows that combining medication and behavioral treatments is a highly effective form of treatment.¹¹

Treatment often includes: ^2,11

• Various forms of behavioral therapy.
• Peer support.
• Psychoeducation.
• Treatment for co-occurring disorders, such as depression or anxiety.

The above interventions can take place in many different settings. Desert Hope in Las Vegas offers evidence-based care through several levels of addiction treatment, including:

• Medical detox.
• Inpatient rehab.
• Intensive outpatient program.
• Partial hospitalization program.
• Sober living.

If you or a loved one are struggling, help is available. If you have questions about treatment or are wondering about your rehab options, please contact one of our caring admissions navigators at to learn more about our inpatient rehab in Las Vegas or other programs that may be right for your needs. Admissions navigators can help you get admitted today and learn more about paying for rehab and insurance plans that cover treatment.

Verify your insurance coverage at Desert Hope by using the confidential .