Risky: Opioids with BZDs

One aspect of the ongoing “opioid crisis” that the media rarely mentions is the potentially deadly impact of benzodiazepines (BZDs) when taken along with opioid pain medications.

BZDs include such drugs as Xanax (alprazolam), Valium (diazepam), Ativan (lorazepam), and Librium (chlordiazepoxide).

According to the American Association of Pain Management, “…(S)everal studies suggest that BZDs may play a role in as many as 80 percent (my emphasis) of unintentional overdose deaths involving opioids.”

That’s an eye-opening statement given the recent, ongoing government crackdown on prescription opioid pain relievers. Taken in context, it means that when taken responsibly, as prescribed, narcotic pain relievers alone don’t live up to their murderous reputation.

BZDs aren’t killers, either, taken responsibly and as directed. Physicians commonly prescribe them to their patients (including those with chronic pain) for relaxation, calmness, relief from anxiety and tension, and as muscle relaxants and/or sedatives.

The problem is that combining opioids and BZDs increases their potential for toxicity and accidental fatal overdose. These drugs are central nervous system depressants: both slow nerve impulses throughout the body and suppress (decrease) breathing. When combined, they may cause further increased sedation, suppressed breathing, impaired motor coordination, and other adverse and potentially deadly effects.

Suppressed breathing causes the most accidental deaths. Opioid pain relievers may do this by themselves, of course, but they’re safe when taken only as directed. Your physician calculates the safest and most effective dose based on your body size, weight, and general health, among other considerations.

If you take more opioid medication than directed, however, you put yourself at risk. Overdosing opioids can slow your breathing to dangerous levels, depriving your organs, including your brain, of vital oxygen. That can obviously have serious consequences. If you stop breathing, well, it’s lights out, baby.

The AAPM states that doctors “may combine BZDs with opioids in chronic pain patients to take advantage of their anxiolytic [anti-anxiety] or skeletal muscle relaxant properties.” But it’s vital to recognize that the two drugs can kill, particularly when misused.

Another potential danger: taking opioids and/or benzodiazepines with alcohol, yet another CNS depressant. Never, ever drink alcohol while taking either of these drugs alone or in combination. To do so risks death.

The U.S. Food and Drug Administration recently announced that it “is requiring class-wide changes to drug labeling, including patient information, to help inform health care providers and patients of the serious risks associated with the combined use of certain opioid medications and a class of central nervous system (CNS) depressant drugs called benzodiazepines.

“Among the changes, the FDA is requiring boxed warnings – the FDA’s strongest warning – and patient-focused Medication Guides for prescription opioid analgesics, opioid-containing cough products, and benzodiazepines – nearly 400 products in total – with information about the serious risks associated with using these medications at the same time. Risks include extreme sleepiness, respiratory depression, coma, and death.”

Many patients with rheumatoid disease take prescription opioids to control their joint pain. They may also take a prescription BZD drug to help them cope with anxiety and depression, or to help them sleep. Please talk to your primary care provider or rheumatologist about the potential risk of combining these beneficial drugs. ^1-3