Polydrug use, or the use of more than one medication or illicit substance at a time, is fraught with risks and concerns. Depending on the substances used, the effects will vary, but when someone uses both an opiate drug, such as painkillers like OxyContin or heroin, and a benzodiazepine like Xanax, the result can be deadly.
Benzodiazepines are depressant medications classified as Schedule IV drugs. Though their classification identifies them as having a low potential for abuse compared to Schedule II or III drugs, benzodiazepine addiction can and does happen with tragic results. Specifically, rapid onset benzos, such as Valium and Tranxene, may often be more addictive than slower onset benzos like Ativan, Xanax, and Klonopin.
Benzos are prescribed as an anticonvulsant and a muscle relaxant as well as for the treatment of anxiety and insomnia. However, these drugs often are misused by people who have legitimate prescriptions for them. Many people feel psychologically dependent even before they develop a physical dependence, nervous of being without the drug and putting themselves at risk of an anxiety attack, seizure, or a sleepless night, depending on their diagnosis. To preempt those issues, others may take the drug before they actually need it or take far more than prescribed. Very quickly, compulsive use of the drug can become an issue, contributing to physical dependence and tolerance that compound the psychological dependence.
Use of opiate drugs, such as heroin and prescription painkillers that include oxycodone or hydrocodone, triggers the pleasure pathway, causing cravings and increasing the likelihood of addiction. Many people report a physical and psychological dependence on the drug within days of first use, especially in the case of injection drug use.
Many people who ultimately develop an opioid use disorder begin their use of opioids with a prescription for painkillers given to them by their doctor. With prescriptions given out when they are not necessarily needed, in too high of a dose, or for too long of a time, a lack of oversight and medical monitoring can contribute to the development of addiction or abuse. For others, recreational use of the drug outside of a personal prescription can contribute to an ongoing problem with opiates and lead to heroin use and abuse.
It’s a serious problem. In 2017, more than 70,000 people died of a drug overdose in the United States, and more than 68 percent of those deaths involved the use of an opiate drug, according to the U.S. Centers for Disease Control and Prevention (CDC). The agency also reports that about 130 Americans die every day due to an opioid overdose, and the rate of opiate overdose deaths was six times higher in 2017 than it was in 1999.
Use of benzodiazepines in combination with opiate drugs creates a synergistic effect in the body. This means that rather than experiencing the effect of benzodiazepines plus the effect of the opiate drug, the user experiences a far more amplified effect of both substances in combination. In other words, one plus one does not equal two in this instance.
The results of this combination, especially when one is new to drug use or when one drug is more potent than expected, can be life-altering, if not life-ending. A few of the risks associated with the use of benzos in combination with opiates can include:
There is no viable reason for driving under the influence of any substance, yet people who are prescribed benzodiazepines or painkillers often do not feel they are too impaired to drive. The fact is, however, that using either opiates or benzos is enough to slow down reflexes and impair judgment, making driving unsafe for the driver, their passengers, and others on the road. When taken together, the ability to make safe choices behind the wheel is all but obliterated, increasing the likelihood of a car accident that could be fatal or an arrest for DUI.
Those who use benzos and opiates are not just at risk of being involved in a car accident but also more at risk of falling victim to any accident compared to those who do not combine the use of these two substances. For example, accidents related to ladder use, fire, or use of machinery at home are more likely to occur when the individual is using opiates and benzos. Many people experience impaired depth perception, slower cognitive function, and a lack of awareness that can make it difficult to perform basic tasks that would otherwise be simple to complete.
Because people often use opiates and benzodiazepines in combination because they are prescribed both drugs for the treatment of different ailments, many people feel it is safe to go to work and continue with business as usual. Unfortunately, the use of these substances together puts the individual in danger and threatens the safety of others in the workplace as well. Especially in certain industries where the individual may be required to drive, operate heavy machinery, climb ladders, or lift and move heavy objects. With a distorted perception of self and surroundings, the individual may be likely to experience musculoskeletal injury, contribute to psychosocial stress on the job, and exhibit decreased performance in all aspects of the job, putting their employment at risk as well as their physical health.
The National Institute on Drug Abuse (NIDA) reports that more than 30 percent of overdoses where opiates were involved also involved benzodiazepines. That means that of the 130 Americans who die due to opioid overdose every day, more than 40 of them were also under the influence of benzodiazepines at the time of their death.
It is a problem with no end in sight. As of 2013, 13.5 million adults filled prescriptions for benzodiazepines, up 67 percent from 8.1 million in 1996, according to NIDA. Every year, the rate of deaths due to overdose increases, driven by a rising rate of opioid overdose fatalities. For every single use of either drug, the risk of death is present, and for every use of both substances in combination, the likelihood of overdose is even higher.
In some cases, physicians who oversee individuals in opiate detox might prescribe benzodiazepines with the goal of helping them to manage the withdrawal symptoms associated with the process. Because benzos are prescribed to manage muscle convulsions, insomnia, and anxiety, and they are a Schedule IV drug, it may seem like a natural fit.
However, people in opiate detox are at risk of relapse when withdrawal symptoms peak. After a period of abstinence, this choice alone can trigger a fatal overdose as the person’s tolerance to their drug of choice may lower during the sober period. If they are also under the influence of benzodiazepines as part of their treatment, the likelihood of fatal overdose increases if they relapse on opioids.
If someone you love is actively abusing opiate drugs of any kind in combination with prescription benzos, do not wait to help them connect with a comprehensive addiction treatment program. The sooner they enroll in drug detox and then continue with intensive therapeutic treatment, the better.
Effective and safe treatment for polydrug abuse comes in the form of a drug rehabilitation program that offers:
Traits of an Effective Treatment Program
In many cases, the individual in crisis due to addiction is not able to accept the need for treatment or to envision what their life might be like without the use of opiates and benzodiazepines. For this reason, it is often concerned family members and close friends who are the ones to take steps to enroll their loved one in treatment. They often secure their loved one a spot in a recovery program that is equipped to help them navigate through detox and addiction treatment.
Are you ready to take a stand and help your loved one recognize that they are living with a life-threatening substance use disorder and that treatment is the only logical next step? Take the time now to get the information you need to help your loved one take a step away from active addiction and closer to a life of balance and healing in recovery.
(January 2013) Benzodiazepines. Drug Enforcement Administration Office of Diversion Control Drug & Chemical Evaluation Section. from https://www.deadiversion.usdoj.gov/drug_chem_info/benzo.pdf
(December 2014) Despite risks, benzodiazepine use highest in older people. National Institutes of Health. from https://www.nih.gov/news-events/news-releases/despite-risks-benzodiazepine-use-highest-older-people
10: Summary: opiate binding in nucleus accumbens and activation of the reward pathway. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/teaching-packets/brain-actions-cocaine-opiates-marijuana/section-iii-introduction-to-drugs-abuse-cocaine-opiat-9
(December 2018) Understanding the Epidemic. Centers for Disease Control and Prevention. from https://www.cdc.gov/drugoverdose/epidemic/index.html
(August 2012) Polydrug abuse: A review of opioid and benzodiazepine combination use. Drug and Alcohol Dependence. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454351/
(October 2016) Opiates and Benzodiazepines on Driving. U.S. National Library of Medicine. from https://clinicaltrials.gov/ct2/show/NCT03447353
(February 2011) Effects of benzodiazepines, antidepressants and opioids on driving: a systematic review and meta-analysis of epidemiological and experimental evidence. Drug Safety. from https://www.ncbi.nlm.nih.gov/pubmed/21247221
(October 2018) Workers Using Prescription Opioids and/or Benzodiazepines Can Face Safety and Health Risks. Centers for Disease Control and Prevention. from https://blogs.cdc.gov/niosh-science-blog/2018/10/26/worker-opioid-use/
(March 2018) Benzodiazepines and Opioids. National Institute on Drug Abuse. from https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids
(September 2017) FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressants: careful medication management can reduce risks. U.S. Food and Drug Administration. from https://www.fda.gov/downloads/Drugs/DrugSafety/UCM576377.pdf