Medically reviewed by Kevin Wandler, MD, Chief Medical Advisor
Opioids and benzodiazepines are each prescribed for real medical reasons. Opioids treat pain, and benzodiazepines treat anxiety, panic, seizures and sleep problems. Some people are prescribed both. Others combine them on their own, or take illicit pills that contain one or both without knowing it. Whatever the reason, this combination deserves special caution.
This article explains why mixing opioids and benzodiazepines is dangerous, how to recognize an overdose, what to do if you are prescribed both, and how to stop safely if you are ready. One key point runs through all of it: do not stop either medication abruptly without medical guidance, because withdrawal can be serious, and benzodiazepine withdrawal can be life-threatening.
Why This Combination Is So Dangerous
Both opioids and benzodiazepines are central nervous system depressants. They slow brain activity, and both can slow breathing. Opioids act on the parts of the brain that control the drive to breathe, while benzodiazepines add their own sedating effect. Together, they can slow breathing far more than either would alone.
The U.S. Food and Drug Administration requires boxed warnings, its most serious type of warning, on opioid and benzodiazepine labels about the risks of using them together, including extreme sleepiness, slowed or difficult breathing, coma and death. The Centers for Disease Control and Prevention also advises prescribers to use particular caution when these medications are combined.
Alcohol, gabapentin, sleep medications and some muscle relaxants can add to the effect, making the risk even higher.
How People End Up Combining Them
- Prescribed together. Someone may receive an opioid for pain from one provider and a benzodiazepine for anxiety from another, and neither provider may know about the other prescription.
- Self-medicating. A person may take a benzodiazepine to sleep or calm down while also using opioids, or use one to ease withdrawal from the other.
- Intentional misuse. Some people combine them to intensify the high.
- Counterfeit pills. Fake pills made to look like prescription opioids or benzodiazepines may contain fentanyl, other synthetic opioids or unapproved sedatives. A person may think they are taking one drug when they are taking both.
Signs of an Opioid and Benzodiazepine Overdose
- Extreme drowsiness or inability to stay awake
- Slow, shallow or stopped breathing
- Gurgling, snoring or choking sounds
- Blue or gray lips and fingertips
- Pinpoint pupils
- Limp body and no response to voice or touch
What to do: Call 911 immediately. If you have naloxone, give it and follow the package directions. Naloxone reverses the effects of opioids but not benzodiazepines, so the person may remain very sedated and still needs emergency care. If they are breathing, place them on their side to keep the airway clear, and stay with them until help arrives.
If You Are Prescribed Both
If your doctors have prescribed both types of medication, do not stop either one suddenly on your own. Instead:
- Make sure every prescriber knows every medication you take, including over-the-counter sleep aids.
- Ask whether the combination is still necessary and what alternatives might exist.
- Avoid alcohol and other sedating substances.
- Talk with your pharmacist about keeping naloxone at home, and make sure the people you live with know where it is and when to use it.
- Report extreme sleepiness or breathing changes to your provider right away.
Managing Pain, Anxiety and Sleep Another Way
People rarely combine these medications for no reason. Often there is real pain, real anxiety or real insomnia underneath. Stepping away from the combination works better when those needs are addressed rather than ignored.
- Anxiety and panic: Therapies such as cognitive behavioral therapy and mindfulness-based approaches teach skills for calming the body and challenging anxious thoughts.
- Sleep: Consistent routines, limiting caffeine and alcohol, and treating underlying depression or anxiety can improve sleep over time.
- Pain: Your medical providers can discuss non-opioid options, physical approaches and other strategies suited to your condition.
These changes take time, which is one reason gradual, supervised plans tend to work better than sudden stops.
Stopping Safely When You Are Ready
Stopping both substances requires careful planning. Opioid withdrawal is intensely uncomfortable and brings a higher risk of overdose if a person returns to use after tolerance has dropped. Benzodiazepine withdrawal can include seizures and can be life-threatening. When both are involved, a medical team needs to decide how to manage each one safely.
At Promises Dallas-Fort Worth, our medical detox provides supervised withdrawal management with medication-assisted treatment used during detox when clinically appropriate. Depending on your situation, care may involve our opioid detox and benzodiazepine detox services working together as one plan.
For many people with opioid use disorder, ongoing medication-assisted treatment is an important part of long-term recovery. Your care team can talk with you about options and how they fit with managing anxiety or sleep without benzodiazepines.
If you are not sure whether your use has become a problem, our article on common signs of opioid misuse can help you reflect on what you are seeing in yourself or someone else.
Frequently Asked Questions
Is it ever safe to take opioids and benzodiazepines together?
Sometimes clinicians prescribe both when the benefits outweigh the risks, but it requires careful monitoring. Never combine them without your prescribers knowing.
Does naloxone work if someone took both?
Naloxone can reverse the opioid part of the overdose, which may restore breathing. It does not reverse benzodiazepines, so emergency care is still essential.
Which one should I stop first?
That decision should be made with a medical provider. The right order depends on your health, the medications involved and how long you have taken them.
Get Medical Guidance Before You Stop
If you are taking opioids and benzodiazepines together and want to stop, please do not try it alone. Our admissions team is available 24/7, and same-day admission is often possible when a bed is available. If you are having thoughts of suicide, call or text 988.
We offer free, confidential insurance verification. Review our insurance options, call (469) 546-9303, or contact us today.