Can Combining Opioids And Benzos Increase Overdose Risk?

By Beth Leipholtz 06/28/18

The National Institute on Drug Abuse reports that more than 30% of all overdose deaths that involve opioids also involve benzodiazepines.

Man taking a pill

When used in combination with opioids, benzodiazepines such as Xanax and Valium can make an individual five times more likely to overdose, a new study published in JAMA Network Open has determined. 

The study found that benzodiazepines, which are often prescribed for anxiety, can increase the likelihood of overdose when used with opioids, especially in the first 90 days they are used together.

The National Institute on Drug Abuse (NIDA) reports that more than 30% of all overdose deaths that involve opioids also involve benzodiazepines.

The new study looked at data from over 71,000 people on Medicare Part D. Researchers divided patients into two groups: those who had taken only opioids prior to overdosing and those who had both opioids and benzodiazepines. Researchers “subdivided [the second group] by the cumulative number of days the patients had taken an opioid with a benzo,” Forbes states.

The results showed that for individuals taking both forms of medication, overdose risk was five times higher during the first three months when compared to those using only an opioid.

For the 90 days after the first three months, the risk of overdose doubled. After six months, the risk decreased to the same likelihood as taking only opioids. 

"Patients who must be prescribed both an opioid and a benzodiazepine should be closely monitored by health care professionals due to an increased risk for overdose, particularly in the early days of this medication regimen," lead study author Inmaculada Hernandez, assistant professor at the University of Pittsburgh School of Pharmacy, said in a press release.

2017 study published in the BMJ found that from 2001 to 2013, simultaneous opioid and benzodiazepine prescriptions in 315,000 privately insured patients increased by 80%. 

As such, one of the factors that researchers considered was the number of clinicians involved with a patient. They found that the more clinicians there were prescribing drugs to a single patient, the greater the risk of overdose.

"These findings demonstrate that fragmented care plays a role in the inappropriate use of opioids, and having multiple prescribers who are not in communication increases the risk for overdose," said senior study author Yuting Zhang, PhD, of the University of Pittsburgh Graduate School of Public Health, according to Forbes.

This study is not the only one of its kind, as the relationship between opioids and benzodiazepines and the associated risks has been studied previously.

Additionally, earlier in 2018, the FDA published a warning about the potential for respiratory depression issues when taking both medications together, since both depress the central nervous system.

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Beth is a Minnesota girl who got sober at age 20. By day she is a website designer, and in her spare time she enjoys writing about recovery at, doing graphic design and spending time with her boyfriend and three dogs. Find Beth on LinkedInInstagram and Twitter.