Alprazolam, known by the brand name Xanax, can make you tired, can be habit-forming, and is tightly controlled due to misuse — so is it an opioid?

Alprazolam is commonly prescribed to treat panic attacks and short-term anxiety. It shares some side effects and risks with opioids, which can lead to confusion. With growing concerns around opioid use and safety, it’s common to wonder whether alprazolam is an opioid.

What Is Alprazolam?

Alprazolam is a benzodiazepine taken as a pill. It’s most often used to treat anxiety and panic disorders. If you or a loved one is taking alprazolam or considering it, you’re not alone — generalized anxiety disorder and panic disorders affect about 12 million people in the United States.

Alprazolam works on gamma-aminobutyric acid (GABA) receptors in the brain. It slows down the central nervous system, which helps you feel calmer and reduces anxiety.

Types of Alprazolam

Immediate-release alprazolam works quickly to help with anxiety and panic attacks. This form usually starts working within about an hour, lasting four to six hours.

Extended-release forms release the medication more slowly, so the effects last longer and you don’t have to take them as often.

Other benzodiazepines used to treat mental health conditions include clonazepam, diazepam, and lorazepam.

What Are Opioids?

Opioids are medicines used to relieve pain. They work by attaching to opioid receptors in the brain to block pain signals and can also affect other parts of the body, like the gastrointestinal tract.

Opioids can be taken by mouth, through the skin (patch), or intravenously (through a vein), and some come in immediate-release and extended-release forms.

The most common medical uses for opioids include:

• Acute pain (short-term pain from injury or illness)
• Cancer-related pain
• Chronic pain
• Pain after surgery
• Palliative care

Types of Opioids

There are three main types of opioids, categorized based on how they are made:

• Natural — Made from the opium poppy, such as codeine and morphine
• Semisynthetic — Made in a laboratory from natural opioids, such as hydrocodone
• Synthetic — Fully made in a laboratory, such as fentanyl

Other common opioids include hydromorphone, methadone, and oxycodone.

What Are the Key Differences Between Alprazolam and Opioids?

The main differences between alprazolam and opioids are how they work in the body and what they are used to treat, as well as their side effects.

Mechanism of Action and Uses

Alprazolam works by binding to GABA receptors in the brain, which helps calm the nervous system. It’s commonly used to treat anxiety and panic disorders.

Opioids bind to opioid receptors in the brain to block pain signals. They’re commonly used to treat acute and chronic pain, cancer-related pain, and postsurgical pain, as well as for palliative care.

Side Effects

Both alprazolam and opioids can cause side effects, which may depend on the dose and how often they’re taken.

Side Effects of Alprazolam

Common side effects include drowsiness and lightheadedness.

Taking too much or taking doses close together can cause alprazolam to build up in the body. This can lead to serious side effects such as slow breathing, blurred vision, loss of balance, seizures, or coma. Seek medical care right away if these occur — some of these effects can be life-threatening.

People who take alprazolam regularly may have withdrawal symptoms if they stop suddenly. These symptoms can include:

• Elevated heart rate and blood pressure
• Sweating
• Seizures
• Anxiety
• Hallucinations (seeing and hearing things that aren’t there)
• Shakiness or restlessness
• Insomnia (trouble sleeping)

Seek medical care right away if you have these symptoms, as severe withdrawal can be life-threatening. Always take alprazolam as prescribed, and talk to your doctor before stopping.

Opioids

Common side effects include drowsiness, dizziness, nausea, and vomiting. Opioids can cause constipation because they affect opioid receptors in the digestive tract.

Taking too many opioids or taking them too close together can cause a buildup in the body and an increased risk of overdose. An opioid overdose can slow or stop breathing, which can be life-threatening. Seek medical care right away if you have trouble breathing while taking opioids.

If you have been taking opioids for a long time and notice cravings or worry about withdrawal symptoms that affect daily life, you may have an opioid use disorder. Talk with your healthcare provider about your symptoms and a safe treatment plan for you.

Why Can Combining Alprazolam and Opioids Be Dangerous?

Even though alprazolam and opioids affect different parts of the brain, they are both central nervous system depressants. This can make you very sleepy and slow your breathing. Taking them together can increase these effects and raise the risk of life-threatening breathing problems.

The combination can be especially dangerous for older adults, people with breathing conditions such as sleep apnea, or those who also drink alcohol. Talk with your doctor to understand what dose and schedule are safe for you.

People who take opioids for a long time may develop tolerance, meaning they need higher doses to get the same pain relief. Higher opioid doses taken with alprazolam can further increase the risk of overdose and life-threatening side effects.

One study in North Carolina found that the risk of overdose death was 10 times higher in people taking both a benzodiazepine like alprazolam and opioids compared to opioids alone.

However, never change your dose or stop taking your medication on your own. Withdrawal symptoms can occur, so it’s important to talk with your healthcare provider about any concerns.

Talk With Your Doctor About the Differences and Risks

At the end of the day, the confusion about alprazolam being an opioid has more to do with how people understand medications than the drugs themselves. When medications are grouped by how they make people feel — such as “downers” for causing sleepiness — it can lead to misunderstandings. Because both alprazolam and opioids can make you drowsy, some people may think they are similar or safe to take together.

Understanding the key differences between alprazolam and opioids can help you make safer, more informed decisions on how you use them. Always talk with your doctor if you have questions or concerns about your medications.

Join the Conversation

On MyOpioidRecoveryTeam, people share their experiences with opioid use and recovery, get advice, and find support from others who understand.

Before today, did you think Xanax was an opioid, and why? Let others know in the comments below.