Posted on Oct 03, 2022, 4 p.m.
Benzodiazepines and opioids include two of the most dangerous drugs of abuse on the market and on the streets today. There’s so much to learn about the dangers of these drugs on their terms. One helpful resource is the drug warnings the Food and Drug Administration (FDA) posts. However, the FDA has also released updated warnings about mixing these dangerous drugs. According to the FDA, here are some of the added dangers of mixing benzos with opioids.
Two of a Kind
Opioids have been a crucial part of pain management in medicine for decades. Morphine specifically has been around since the turn of the 19th century as a synthetic drug derived from the opium plant. It has a history of use in pain management for surgeries and battlefield trauma. Today, much more potent opioid drugs, including the dangerous fentanyl, are available. However, all modern opioid varieties are usually compared to morphine as the gold standard to compare and contrast their strength. Between the 20th and 21st centuries, opioids were so widespread that more than 2.5 million people were struggling with addiction by 2015. A large part of this addiction epidemic was the marketing of the drug OxyContin.
Benzodiazepines have a history of treating anxiety, insomnia, muscle spasms, and panic disorders, although their history is more recent than opioids. In fact, benzos were marketed as a safer alternative to the problematic barbiturate drugs that had unfortunate abuse and addiction potential. Unfortunately, benzodiazepines were heavily marketed and prescribed worldwide, eventually topping over 135 million annual prescriptions by 2013.
The FDA’s Black Box Warning
By 2016, the FDA stepped in to update its labeling requirements for opioids and benzodiazepines, assigning its black box warning to more than 400 prescription medications. This warning is the agency’s most significant warning about drugs with a high potential for abuse and/or death. However, this alert was not restricted to the use of these drugs in isolation; it also carried additional warnings for combined use.
This initial warning mentioned how opioids and benzodiazepines are central nervous system (CNS) depressants, a class also shared with alcohol. The reason this point is so important is that people using these drugs could be under the assumption that since these drugs are different, they are safe to use together. However, CNS depressants of any kind, when used together, can cause a CNS depressant overdose. For example, wine and beer are different types of alcoholic substances, but alternating between the two is not a safe method to keep from intoxication.
Among the black box risk, details include the communication that combined use could lead to difficulty breathing, coma, and even death. With both drugs in high demand and millions suffering from either benzo or opioid addiction in the 21st century, the percentage of combined use was high enough that the FDA deemed it necessary to send out this warning.
While this communication was significant on its own, the FDA updated its warning information yet again in 2017, insisting that the risk of combining these drugs was still very high. However, the benefit of using these two drugs together in a controlled medical environment should not be avoided entirely. However, the risk of mixing benzodiazepines with prescription opioid cough medication is such a threat to breathing and consciousness that even health care professionals are advised to avoid mixing these drugs together at any time.
This updated warning teaches us two things. First, it teaches us that the FDA considers mixing benzos and opioids so dangerous that only health care professionals should do this and heavily monitor their patients at that. Secondly, there are even stipulations given to health care professionals and limits to the scenarios valid for combined use, such as “to patients for whom alternative treatment options are inadequate.” With those two points in mind, general use, recreational use, and avoidable combination of these two drugs are too dangerous to risk at any time whatsoever, per the FDA’s safety communications.
When we take the FDA’s messaging seriously, we should consider how dangerous it is to combine these drugs. On the one hand, we’re reminded that the FDA releases communications only after pulling much data and research together and analyzing it. In other words, there are sad statistics to back up the warnings coming from the FDA. But on the other hand, we can see just how necessary it is to seek treatment if you or someone you know is struggling with benzo addiction, opioid addiction, or a combined substance use disorder of the two.
This article was written for WHN by Kevin Morris from the Delphi Behavioral Health Group, a dedicated family of facilities committed to offering individualized treatment for all levels of addiction working to treat it at its core to provide those suffering with the tools to start a journey of long-lasting recovery.
As with anything you read on the internet, this article should not be construed as medical advice; please talk to your doctor or primary care provider before changing your wellness routine. This article is not intended to provide a medical diagnosis, recommendation, treatment, or endorsement.
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References/Sources/Materials provided by:
Delphi Health Group. (n.d.) Guide to Benzodiazepine Addiction and Treatment. Retrieved https://delphihealthgroup.com/benzodiazepines/
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Delphi Health Group. (n.d.) The Most Potent (Strongest) Opioids Currently Available. Retrieved https://delphihealthgroup.com/opioids/most-potent/
CDC. (2022 Feb 23). Fentanyl Facts. Retrieved https://www.cdc.gov/stopoverdose/fentanyl/index.html
Delphi Health Group. (n.d.) Oxycodone Addiction: What Side Effects Should You Know About? Retrieved https://delphihealthgroup.com/opioids/oxycodone/
Yale Medicine. (2019 Dec 11). Are Benzodiazepines the New Opioids? Retrieved https://www.yalemedicine.org/news/benzodiazepine-epidemic
FDA. (2020, Sep 23). FDA Drug Safety Communication: FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Includes potential for abuse, addiction, and other serious risks. Retrieved https://www.fda.gov/media/142368/download
FDA. (2016, Aug 31). New Safety Measures Announced for Opioid Analgesics, Prescription Opioid Cough Products, and Benzodiazepines. Retrieved https://www.fda.gov/drugs/information-drug-class/new-safety-measures-announced-opioid-analgesics-prescription-opioid-cough-products-and#:~:text=FDA%20is%20warning%20patients%20and,breathing%2C%20coma%2C%20and%20death.
Delphi Health Group. (n.d.). Guide to Alcohol Detox: Severity, Dangers, and Timeline. Retrieved https://delphihealthgroup.com/alcohol/detox/
FDA. (2017 Sep 20). FDA Drug Safety Communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. Retrieved https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-about-serious-risks-and-death-when-combining-opioid-pain-or