Why Mixing Opioids and Benzodiazepines Is So Dangerous

If you have even been paying a tiny amount of attention to the news, then you know that one of the major public health crises in the United States is the opioid epidemic. These powerful narcotics include illegal compounds like heroin as well as manufactured medications like morphine, codeine or fentanyl.  Opioids have an immense ability to block pain and are therefore necessary for certain medical interventions. However, they also can be highly addictive and pose serious health risks when abused.

Another epidemic that is occurring, but with less media attention, involves benzodiazepines. Benzodiazepines are also prescription drugs, but these are sedatives used to treat anxiety or insomnia.  Among this class of drugs is Valium, Xanax and Klonopin.

Surge in Use of Opioids and Benzodiazepines

In the United States, there has been an overwhelming demand for potent medications to treat widespread health conditions like chronic pain and anxiety. This has often made medical doctors the dealer of choice for psychoactive drugs.

The opioid crisis originated in the 1990s when opioid drug manufacturers pushed doctors to prescribe their products. Drug makers reassured physicians that their opioid medications were not addictive, despite strong evidence that the opposite was true.

Since then opioid use has rapidly risen in the U.S. In 2016, doctors wrote Americans more than 214 million opioid prescriptions. That means that almost one in five Americans are currently on opioids which has led to widespread misuse and abuse. It is estimated that almost 11 million people abused opioids in 2016.

This epidemic of opioid use has staggered many communities and hospitals across the nation.  More than a thousand people visit the emergency room every day due to opioid-related issues. Tragically, in 2017, almost 47,000 Americans died from opioid overdoses.

Like opioids, benzodiazepines are overused in the United States.  In 2008, more than 16 million Americans, or five percent of the U.S. population, was on benzodiazepines.  Also like opioids, it is easy to become addicted to benzodiazepines; it is estimated that 44 percent of all users will become dependent upon them.

Benzodiazepines are also extremely dangerous. One study found that benzodiazepines caused more early deaths than any other prescription medication. The study concluded that benzodiazepines actually double the risk of an early death.

How Opioids and Benzodiazepines Act on the Body

You should keep in mind that although opioids and benzodiazepines have certain benefits, they are actually quite toxic.  Opioids have many deleterious effects upon major organ systems including:

  • Kidney—if you lay without moving for long periods, which is common among opioid users, your muscles begin to breakdown. The chemical byproducts of this process actually poison the kidneys.  This can lead to kidney failure, forcing the patient to use dialysis or get a kidney transplant.
  • Liver—opioids, like all drugs, damage the liver. However, opioids are especially toxic because they are often combined with acetaminophen, another highly toxic drug. Liver disease is very common among opioid users.
  • Heart—your circulatory system is at great risk with opioid abuse.  Heart attacks are twice as likely with opioid use. If the opioid is injected there is serious risk of infection or damaged blood vessels.
  • Lungs—one of the key dangers of opioid use is its ability to suppress breathing. Not only can it lower the frequency and intensity of breathing, but it also raises the risk of life-threatening infections like pneumonia.
  • Digestive system—opioids suppress appetite by slowing the digestive process. This can lead to nausea, vomiting and bowel distention.
  • Bones—opioid use weakens bones, making you more vulnerable to fractures. Just two weeks of opioid use may be enough to thin bones enough for a break.

Benzodiazepines act primarily on the brain, but these effects impact many important organ systems. Primarily, these drugs slow the brain down by boosting levels of the neurotransmitter GABA.  As the brain slows, it becomes impaired in the following ways:

  • Impaired balance
  • Poor blood pressure regulation
  • Memory loss
  • Suppressed breathing

Combining Opioids with Benzodiazepines

Given the many danger of opioids and benzodiazepines, it shouldn’t surprise you that combining them makes the risks considerably greater. It has been reported that almost 30 percent of all opioid overdoses also involve benzodiazepines. Unfortunately, many patients are prescribed both kinds of drugs. One study found that between 2001 and 2013, the number of people on opioids and benzodiazepines jumped 17 percent.

Recent reports indicate that the risk of fatality rises significantly when combining opioids with benzodiazepines. A study in North Carolina reported that the likelihood of an overdose death was ten times higher among patients on both kinds of drugs than those only on opioids.

The key reason for this uptick in lethality is the combined effect on respiration. Separately, both drugs suppress breathing to somewhat dangerous levels, but in combination, the effect is virtually fatal in many circumstances. Also, the risk of lowered respiration is exacerbated by the sedative effects of both drugs. Many users may experience respiratory distress, but they are too sedated to seek help.

Furthermore, these risks are heightened by the habitual behavior of the users.  It appears that benzodiazepines elevate the pleasure response when opioids are used, and this enhanced high makes it even more difficult to break out of the cycle of addiction. Once experienced, this drug combination is very difficult to quit.

How to Avoid Taking Opioids with Benzodiazepines

Multi-drug interactions are a common threat to patients with more than one health condition.  While it is important to tell your doctor about any and all medications you are taking, it is especially important if you are taking benzodiazepines or opioids.  You may forget to list all of the drugs you are on with a new doctor, but do your best to mention it, especially if you are about to go through a surgical procedure.

If you are unsure if any of your medications are opioids or benzodiazepines, consult with your doctor or pharmacist.  They may be able to replace one of your medications with a comparable alternative.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA and you should not post any of your private health information. 

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