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Some medications can help people manage pain, anxiety, panic attacks, or sleep problems. But certain drugs become much more dangerous when they’re taken together. One of the riskiest combinations involves opioids and benzodiazepines.
Both medications can be useful and effective when they’re used as prescribed by a healthcare provider. But because they can both slow activity in the brain and body, taking them together can lead to sedation (extreme drowsiness), respiratory depression (dangerously slow or stopped breathing), overdose, and even death.
Many people don’t realize how serious this interaction can be. Someone may take an opioid for pain and a benzodiazepine for anxiety or insomnia (difficulty falling asleep or staying asleep) without knowing that the combination can significantly increase the risk of overdose.
In some cases, people were taking medications exactly as prescribed and still had dangerous side effects.
Doctors and public health experts have warned about this combination for years. In fact, both the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) have issued warnings about using opioids and benzodiazepines together, due to the increased risk of respiratory depression and fatal overdose.
Here’s what to know about opioids and benzodiazepines, why doctors prescribe them, and why combining them can be so dangerous.
Benzodiazepines, often called “benzos,” are medications that slow activity in the brain and nervous system.
Common benzodiazepines include:
These are most commonly prescribed for:
Benzodiazepines work by increasing the effects of gamma-aminobutyric acid (GABA), a brain chemical that helps calm nerve activity. This slows signaling in the brain and creates a calming effect. As a result, people may feel more relaxed, sleepy, or less anxious after taking them.
Doctors usually recommend using benzodiazepines for a limited period when possible because they can become habit-forming over time. Long-term use may lead to physical dependence, meaning the body adapts to the medication and may develop withdrawal symptoms if it is stopped suddenly.
Stopping benzodiazepines abruptly can cause withdrawal symptoms, which is why doctors usually recommend gradually tapering (reducing the dose) rather than stopping the medication all at once.
Opioids are powerful pain-relieving drugs. Prescription opioids include:
Doctors may prescribe opioids for acute (short-term) pain, such as pain after surgery or a serious injury, or for severe pain related to conditions such as cancer.
These medications work by attaching to opioid receptors (proteins that help control pain signals) in the brain and body. This action reduces the feeling of pain and can also create feelings of relaxation or euphoria (an intense feeling of pleasure or well-being).
Like benzodiazepines, opioids slow the central nervous system (the brain and spinal cord) and carry risks of physical dependence, opioid use disorder (OUD), overdose, and death, especially when taken improperly or at high doses.
Some opioids, especially fentanyl, are extremely powerful. Even small amounts can become dangerous when mixed with other substances that slow breathing or cause drowsiness.
The biggest danger is that both drugs can depress (slow down) the central nervous system. The CNS controls critical functions like:
When opioids and benzodiazepines are taken together, their effects can add up and become stronger. This means the body may slow down much more than expected.
Possible effects include:
Respiratory depression is the most serious risk. Breathing may become dangerously slow or stop completely, which can prevent enough oxygen from reaching the brain and other organs. This can quickly become life-threatening.
According to the National Institute on Drug Abuse, people who use opioids and benzodiazepines together are at much higher risk of emergency department visits, hospitalization, and fatal overdose than people who use opioids alone.
Together, these effects can slow breathing and make a person dangerously drowsy.
A person may become so sedated that they have trouble staying awake or breathing normally. Oxygen levels can fall dangerously low, especially during sleep. In severe cases, the brain and organs stop getting enough oxygen to function properly, which can become life-threatening without prompt treatment.
This can happen quietly. Someone may look like they’re sleeping when they’re actually having an overdose. The risk becomes even greater when alcohol or other sedatives are involved, because these substances can also slow breathing and increase drowsiness.
Sometimes people intentionally use opioids and benzodiazepines together, a practice known as polysubstance use (using more than one drug or substance at the same time). But many dangerous situations happen by accident.
For example, someone may receive opioid pain medication after surgery while already taking a benzodiazepine for anxiety. Another person may see different healthcare providers who aren’t aware of all the medications they’re taking.
Others may assume prescription drugs are automatically safe to take together because they were prescribed by healthcare professionals. Unfortunately, that’s not always the case. Even when medications are prescribed appropriately, some combinations can increase the risk of serious side effects and overdose.
Some groups face especially high risks when opioids and benzodiazepines are taken together.
Older adults often process medications more slowly and are more likely to take multiple prescriptions at once. This can increase the risk of overdose, confusion, falls, and breathing problems.
Conditions like chronic obstructive pulmonary disease (COPD), asthma, emphysema, and sleep apnea already affect breathing. Opioids and benzodiazepines may worsen these conditions by further slowing breathing.
Higher doses of opioids or benzodiazepines can increase the risk of severe sedation and respiratory depression.
Alcohol, sleep medications, and muscle relaxants can further slow breathing and increase drowsiness, raising the risk of overdose.
People with a history of addiction or substance misuse may face a higher risk of overdose and other harmful effects when using opioids and benzodiazepines together.
Recognizing the signs of an overdose quickly can save a life. Warning signs include:
If someone cannot be awakened, has slow or stopped breathing, or appears to be experiencing an overdose, call 911 or your local emergency number immediately. If naloxone is available, give it as directed while waiting for emergency help to arrive.
Naloxone is a life-saving medication that can reverse an opioid overdose. It works by blocking the effects of opioids in the brain and helping restore normal breathing.
The CDC recommends that people at higher risk of overdose, including those taking opioids and benzodiazepines together, have access to naloxone.
Some naloxone products, including naloxone nasal spray, are available over the counter, meaning you can buy them without a prescription. These products are designed to be easy to use and provide a premeasured dose.
However, naloxone only reverses the effects of opioids. Emergency medical care is still needed after naloxone is given. This is because its effects may wear off before the opioids have fully left the body, and benzodiazepines or other substances may continue to affect breathing.
People should never stop opioids or benzodiazepines abruptly without medical guidance. Suddenly stopping benzodiazepines may cause:
Stopping opioids suddenly can also cause withdrawal symptoms such as nausea, sweating, chills, muscle aches, diarrhea, anxiety, and intense cravings. Although opioid withdrawal is usually not life-threatening, it can be extremely uncomfortable and may increase the risk of returning to opioid use.
Doctors often recommend a slow taper, which means gradually reducing the dose over time, to improve safety and reduce withdrawal symptoms. Always work with a healthcare provider before making any changes to your medications.
Healthcare providers are now much more careful about prescribing opioids and benzodiazepines together. To help reduce the risk of overdose and other serious side effects, doctors may:
You can also help reduce your risk by:
Opioids and benzodiazepines can both play an important role in medical treatment, but combining them can become dangerous very quickly. Because both drugs slow the central nervous system, taking them together can slow breathing and increase the risk of overdose, especially when alcohol or other sedatives are involved.
Older adults and people with breathing conditions face an even higher risk. Knowing the warning signs of overdose, having naloxone available, and working closely with a healthcare provider can help reduce the risk of an emergency.
Most importantly, these medications should never be stopped suddenly without medical supervision. Careful monitoring and clinician-guided tapering can help people use these medications more safely and reduce the risk of withdrawal symptoms.
On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.
Have you checked whether any medications you take could become dangerous when combined? Let others know in the comments below.
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