The question of whether or not taking benzos and opioids in combination can be dangerous or not has been a topic of great interest in the past several years. Studies show that dangerous side effects related to polysubstance use do exist. However, there are no simple, one-size-fits-all answers to this dilemma.
What Are Opioids and Benzos?
Physicians typically prescribe opioids to address pain in their patients. The pain may be chronic and require long-term or lifelong treatment. It may also be temporary, resulting from an injury or accident.
Common opioid drug names include:
- Fentanyl
- Tramadol
- Oxymorphone
- Oxycodone
- Hydrocodone
- Hydromorphone
- Buprenorphine
- Morphine
- Methadone
Benzodiazepines, commonly referred to as “benzos”, are classified as central nervous system depressant drugs. They are used to treat conditions like seizures, anxiety, panic, depression, and insomnia. Benzos also assist with muscle relaxation, nausea, vomiting, and sedation for diagnostic procedures and surgery. They also help reduce symptoms of alcohol withdrawal and drug-associated agitation.
Common benzodiazepines include:
- Clonazepam
- Alprazolam
- Lorazepam
- Diazepam
- Triazolam
- Chlordiazepoxide
- Flurazepam
Dangers of Polysubstance Use
Polysubstance or polydrug use involves ingesting more than one type of drug simultaneously or at overlapping intervals. This act can involve the use of illegal narcotics either taken by someone addicted to them or by a person using them recreationally.
In many other cases, physicians prescribe a combination of medications that treat drug and alcohol addiction. While this act often does not involve a notable risk to the patients, in some cases it does. In particular, a combination of opioids and benzos can have distressing side effects. This has made the topic the subject of much discussion and debate in the medical community.
Risks from combining opioids and benzos can include:
- Extreme sleepiness
- Respiratory distress
- Slowed or difficult breathing
- Unusual dizziness
- Coma
- Death
The FDA Warnings About Combining Opioids and Benzos
A 2016 report from the U.S. Food and Drug Administration (FDA) reported a new requirement that patient information and drug labeling must now inform prescribers and consumers of risks associated with using opioids and benzos concurrently.
The FDA implemented requirements for warnings and medication guides for opioid analgesics, cough products containing opioids, and benzos. This warning affects almost 400 products. The warning informed users that if they used opioids and benzos together, they should consult their health care provider to see if they recommended continued combined usage.
Just a year later, the FDA amended its warning to state that a combination of opioid and benzo prescriptions should not be withheld from patients. The FDA stated that while using the drugs together increased the risk of side effects, medication management assistance from medical professionals helped reduce the risks.
The FDA 2017 report recommendations to health care providers for handling possible polysubstance abuse resulting from combining opioids and benzos include the following:
Educating patients: Talk to patients about the risks of combined usage, both when used as prescribed or otherwise.
Tapering Off: When possible, set goals to taper off one or both drugs.
Ensure Multiple Prescriber Awareness: If a patient receives their polysubstance prescriptions from more than one prescriber, make sure all of them are aware of each prescription.
Verify Diagnoses and Options: Confirm that all diagnoses a patient states they have are valid and consider other possible treatment options.
Utilize Drug Testing: Monitor patients for illegal drug usage via urine or blood testing.
Understand the Value of MAT: Medication-assisted treatment (MAT) is the combination of medication with counseling and behavioral therapies as a treatment for substance use disorders. The value of MAT medications should be weighed wisely against the risks associated with them.
Communication Contributes to Reducing Dangers of Polysubstance Abuse
When it comes to potential polysubstance abuse, one key factor involves communication. All prescribing doctors should be informed of the treatment plan and any alterations to it. Patients with a history of substance use disorders are at a higher risk for misuse, particularly those who experienced opioid addiction.
The patient should be educated about the risks associated with using opioids and benzos together. Knowing how to weigh the risks against what treatment plan is best for them helps them make informed decisions.
The concept of “harm reduction” helps some patients better understand the risks. While harm reduction often centers on the usage of illegal narcotics, in this case, it refers to using legal prescriptions to help treat addiction. Harm reduction involves choosing less risky avenues of drug usage to give patients the greatest chance to experience little to no harm. While there are some risks to combining opioids and benzos, when they are consistently monitored, they often outweigh the risks of a patient going untreated.
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