- Mixing opioids with benzos ups the risk of an overdose.
- Many people take benzos while in treatment to handle withdrawal from opioids, which is also a dangerous combination.
- Doctors ideally work with patients to taper down the benzos.
Benzos, anti-anxiety drugs including Klonopin and Xanax, are widely prescribed. But they are addictive drugs and withdrawal can be rough when you try to taper off.
Many people with pain issues, who take opioids like Percocet or OxyContin, also have anxiety; the two feed each other biologically. In the midst of the opioid crisis, it became clear that people who were dependent on both opioids and benzos were in the most danger. Taking a benzo alongside opioids bumps up the chances of a fatal overdose by nearly four times, according to one large study. The numbers are also scary when benzos are mixed with buprenorphine, the medication for symptoms when going off an opioid. Some 20 to 43 percent of people getting anti-addiction meds have a prescription for a benzodiazepine to manage insomnia or anxiety. For example, in a study of more than 63,000 Massachusetts patients a quarter filled at least one benzo prescription while under treatment with buprenorphine. That group had triple the chance of a fatal opioid overdose and were twice as likely to die for any reason, compared with those who didn’t.
This phenomenon won’t be a big surprise to doctors. They face a puzzle. The FDA has advised them not to withhold the anti-addiction medicine from people taking benzos, saying that the risk of untreated opioid use disorder is greater than the risk of combining drugs like buprenorphine with benzos. Patients also can get benzos illegally and they often do.
The goal is to help patients taper off. Doctors hope to nudge their patients off benzos over time and believe they’ll lose the patient if they push too hard, according to additional research. There’s truth to that idea. In the Massachusetts study, the patients who took benzos were 13 percent less likely to stop taking their buprenorphine.
The problem is that benzos, like opioids, backfire. They can make you more anxious, not less. As one doctor put it, “That conversation is a really tough one, like telling a patient, ‘look, you’ve been on Xanax for like 30 years, but I feel like that’s contributing negatively to your anxiety, insomnia’ and nobody wants to come off. And nobody has programs that focus on getting people off benzos. You essentially end up with these patients on benzos. And the easiest thing is for us to just keep writing this prescription.”
Some would say doctors are fueling yet another addiction. It’s true that patients tend to abuse benzos early in treatment. “I’d mix Xanax and Klonopin and take them on a high dose of methadone; I would be pretty much high all day,” one patient said.
Patients tend to focus on the benefits of benzos. “It could potentially be dangerous, but nothing else has seemed to help me,“ one said. Others don’t think that the risk of benzos applies to them. As one example, a patient who bought benzos illegally said, “Most people in my life don’t agree with taking them. They think that it’s close to using, but if it's helping me with my anxiety attacks, that’s fine.”
If that sounds like someone you care about, you're right to be concerned. You also may need to be patient. Doctors ideally work with patients to taper down the benzo. “A combination of increased monitoring of patients taking benzodiazepines, limiting benzodiazepine doses, and undergoing slow, patient-guided dose reduction when necessary, may be a way to navigate this difficult, but not uncommon, clinical scenario,” writes a team at Boston University, led by Tae Woo Park, MD, assistant professor of psychiatry. Just cutting someone off will probably lead to street purchases.
If you are in a relationship with someone who struggles with addiction, it's easy to try to limit the damage by covering up mistakes, making excuses, and trying to control access to the drug. All of these moves may seem necessary. In the long run, however, someone with an addiction needs to take responsibility for it.
- Let your loved one face the consequences of their actions, no matter how hard this may be.
- Let them handle the things that they are responsible for.
- Do not feel guilty for your loved one’s substance use, as this is their problem to solve.
- Tell them that you are concerned and that their substance use is a serious problem.
- Suggest treatment options.
- Make a commitment to take care of yourself first.