Why are Doctors so Quick to Prescribe Benzodiazepines and Opioids Together?

This is a good question. Prescribing benzodiazepines and opioids seems to come very easily to physicians today. The worst part of this practice is that prescribing benzodiazepines and opioids together can be very dangerous and even deadly. These two classes of drugs should never be taken together, just the same as neither one should be mixed with alcohol. However, the rate of doctors dispensing prescriptions for benzodiazepines and opioids to the same patient has increased tremendously.

The Centers for Disease Control and Prevention (CDC) warns against physicians prescribing benzodiazepines and opioids together when at all possible. In many overdose deaths, the toxicology reports show both of these drugs in the victim’s system. Numerous hospital emergency room visits which result in hospital admissions are because of patients mixing these two drugs. Opioids and benzodiazepines now have Federal Drug Administration (FDA) warnings on the labels about the dangers of mixing these drugs.

What are Benzodiazepines and Opioids?

To understand why prescribing benzodiazepines and opioids together is such a dangerous practice, first, you have to understand what exactly the two drugs are. Benzodiazepines are a class of psychoactive drugs. They are used to treat anxiety disorder, insomnia, seizures, and relax muscles. This is one of the most highly prescribed medications in the United States today. Benzos have the potential for tolerance, dependence, addiction, and overdose. If you mix these drugs with alcohol or some other substances, including opioids, it can end up with a fatal result.

Side effects of benzodiazepines can include but are not limited to:

• Headache
• Drowsiness
• Impaired vision
• Dizziness
• Grogginess
• Feelings of depression
• Trembling
• Confusion
• Impaired coordination

If a person has become dependent on benzodiazepines, it is critical that they do not stop taking this drug “cold turkey.” Stopping the drug this way can lead to withdrawal symptoms like muscle cramps, tremors, and life-threatening seizures. It is much better to seek professional help and slowly taper off these drugs. If a person has overdosed on benzodiazepines, some of the symptoms will be:

• Slurred speech
• Intoxication
• Impaired balance and movement control
• Central nervous system depression

Benzodiazepine overdoses are not usually fatal unless they are mixed with other substances such as tricyclic antidepressants, alcohol, opioids, or barbiturates.

Opioids are a class of drugs which are derived from the opium poppy plant. Some of the prescription opioids are made in labs using the same basic structure as the poppy plant while others come directly from the plant. Opioids contain chemicals which relax the body and reduce pain. Most prescription opioids are used to treat moderate to severe pain. However, these drugs also give the user a feeling of euphoria. This feeling of euphoria and being “high” is why so many prescription opioids are abused and used by individuals who have not been prescribed the drug but instead get them from friends or buy them on the streets.

Like benzodiazepines, opioids have the potential for tolerance, dependence, addiction, and overdose. Opioids (like benzos) can too be fatal when mixed with alcohol or other substances. Side effects of opioids can include but are not limited to:

• Euphoria
• Drowsiness
• Constipation
• Confusion
• Slowed respiration
• Nausea

If a person is dependent or addicted to opioids, withdrawal symptoms can begin in as little as a few hours after last taking the drug. These symptoms can be extremely uncomfortable and even painful. For this reason, many opioid users remain addicted to the drug. Some of these withdrawal symptoms include:

• Severe cravings
• Nausea and vomiting
• Muscle and bone pain
• Goosebumps as a result of cold flashes
• Uncontrollable leg movements
• Extreme insomnia

Most opioid overdoses occur when the prescription or illicit opioid is mixed with alcohol or other drug combinations; however, it is possible to overdose on opioids alone. Opioid overdose symptoms include:

• Pinpoint pupils
• Marked confusion, delirium, or simply acting drunk
• Vomiting
• Extreme sleepiness or inability to wake up
• Slowed or irregular breathing
• Intermittent loss of consciousness
• Seizures
• Respiratory arrest (not breathing at all)
• Purple or bluish color around mouth and nails

If an individual who is experiencing an overdose is left alone while they are sleeping, their respiratory system will continue to worsen until it stops completely resulting in death.

Prescribing Benzodiazepines and Opioids Together

With the potential for abuse and addiction that both of these drugs have, why then are doctors prescribing benzodiazepines and opioids together? We have to ask, “What could they be thinking?” Benzodiazepines enhance the effects of opioids, so it stands to reason that a person who abuses one drug for the “high” would take them both together to obtain an even better high. The only problem is, that high could very easily be their last!