- Effects of Benzodiazepines on the Brain
- What Happens When You Combine These Two Drugs?
- Why Do Some Users Combine Sedatives with Opiates?
- Associated Social and Mental Health Problems
Effects of Opiates on the Brain
As prescribed, opiates are indicated for the management of various levels of pain. However, some users additionally take opiate drugs for their other inhibitory or depressant effects—which can include a marked sedation and pleasant euphoria.
- The mu opioid receptor is primarily implicated in producing the effects of opioids.
- Although one of their agonist effects is to elicit a euphoric sensation, opioids are often referred to as depressants because they slow down normal processes in the body and delay response time by changing the way the brain sends and receives signals.
Effects of Benzodiazepines on the Brain
Benzodiazepines (e.g., Xanax, Valium, and Ativan) are sedatives that are often prescribed to treat anxiety disorder and panic disorder. Benzodiazepines exert their sedative effects by enhancing the activation of GABA receptors.
- Taking high doses repeatedly can cause excessive receptor binding that can lead to sedation or even unconsciousness.
- Prolonged benzodiazepine use results in the desensitization of neurotransmitter sites, causing them to become less responsive over time.
- This can lead to the development of tolerance, wherein the tolerant individual requires larger doses to be consumed in order to have the same effects.
What Happens When You Combine These Two Drugs?
Opiate abuse can lead to:
- Extreme drowsiness.
- Suppressed hand and eye coordination.
- Reasoning problems.
Similarly, abusing a sedative can result in:
- Serious fatigue.
- Concentration problems.
- Induced sleep.
Combining these types of drugs may also cause the following:
- Muscle weakness.
- Decreased motor coordination.
- Falls or other injuries.
- Cardiac rate and rhythm irregularities.
- Profound respiratory depression.
Statistics or Prevalence
In the United States, it is likely that a patient who is prescribed benzodiazepines will also have, at some point, received a prescription for opiates.
- Half of this group is likely to report that they had started to use the sedatives after entering treatment for opiate abuse.
- According to a 2011 report that was published by the National Institute on Drug Abuse, the use of benzodiazepines amongst adolescents is gradually rising—7.4% of youths have reported taking this drug for non-medical reasons.
- In addition, a 2014 study showed that emergency room visits that were the result of combining benzodiazepines and opiates had risen by almost 90%.
- It has also been reported that people who co-abuse benzodiazepines and opiates also combine them with alcohol, which is an especially dangerous mixture.
Due to the combined risks of respiratory depression associated with the combination of opiates and sedatives, the rate of accidental death as a result has been found to be as high as 80% of all opiate-related mortality.
- A report that was published in 2014 also stated that death rates have increased five-fold due to benzodiazepine use and that concurrent opiate abuse have often contributed to these deaths as well.
Furthermore, accidental opiate-related fatalities have increased four-fold from 1999 to 2009.
- Similarly, a 2013 study in the Journal of the American Medical Association (JAMA) released data which showed that deaths from opiates were implicated in 75% of fatalities, followed by benzodiazepines at 29%.
Why Do Some Users Combine Sedatives with Opiates?
Three reasons for combining the two drugs can be speculated:
Patients in long-term opiate treatment centers have even stated that curiosity, tension or anxiety relief, relaxation, and the desire to get high are among the reasons they started concurrent benzodiazepine use.
- Systemic issues in medical management. More specifically, the problem of “polypharmacy”—related to the co-prescription of both drugs, for example.
- To seek relief from issues related to each—for example, taking a sedative to counter the bad dreams that opiates elicit, in some cases. Individuals that are prescribed opioids for chronic pain routinely experience anxiety and depression. Therefore, they may start taking sedatives to combat the anxiety.
- To enhance the positive, often euphoric effects exerted by each. Evidence also suggests that benzodiazepines may potentiate the positive (e.g. euphoria, relaxation) effects of opiates, therefore increasing the incentive to continue combined use.
According to research, the concurrent use of opioids and benzodiazepines presents quite a challenge for clinicians who treat chronic pain patients. In most cases, this is due to the observation that people suffering from chronic pain who co-abuse these two drugs had more problems related to behavioral and pain-management issues. This group were also at higher risk of non-fatal and fatal overdose.
Medical therapies used in the treatment of opiate abuse are often administered in the form of opiate replacement therapy, in which the patient takes progressively decreasing doses of a drug similar to the opiate they had abused over time.
- In particular, medical treatment for opiate dependence typically entails a detoxification process with drugs such as Suboxone, methadone, naltrexone, buprenorphine or some combination thereof to gradually taper patients off of an opiate that was being misused.
- Fewer side effects are experienced when this procedure is followed than if a patient stops taking the drug abruptly.
- Unfortunately, the relapse and opiate overdose rates remain high. As a result, this form of therapy is most effective when it is offered at in-patient treatment centers.
The psychological aspects of concurrent drug abuse (e.g., depression, sleep disturbances, anxiety) may also be addressed through cognitive behavioral therapy (CBT).
- This type of therapy entails improving impulse control, distress tolerance, assertiveness, and the regulation of emotions because heightening these skills has a positive effect on decision-making and behavior.
- The therapeutic sessions also involve presenting real-life scenarios to the patients and then teaching them strategies that can help them overcome situations that could cause relapses.
- CBT has proven beneficial in helping patients who are struggling with substance abuse.
Drug replacement therapy and/or psychotherapy may be delivered in treatment centers that the patient can attend regularly while still living at home and continuing to meet work or school-related obligations. This is known as outpatient therapy, and may be best for some patients based on their individual preferences and/or co-existing conditions (e.g. anxiety).
The options as above may also be delivered in specialist clinics or facilities in which the patients are accommodated for the duration of their treatment (i.e. inpatient treatment). Again, the choice between inpatient and outpatient forms of treatment depend on factors such as:
- The severity of the abuse problem,
- A patient's circumstances and responsibilities.
- A patient's own choices in relation to treatment.
Residential treatment centers are live-in heath care facilities that have a range of treatment options available to give you an immersive treatment experience. The main benefit of a residential facility is the removal of environmental triggers and stresses that precipitate relapse to active use and prevent complete recovery.
Associated Social and Mental Health Problems
Considering the complications of treatment and myriad underlying factors, those concurrently abusing both opiates and benzodiazepines generally have poorer treatment outcomes.
A treatment program specifically geared to addressing polydrug use would be beneficial in such instances.
Further, compared to abusing either opiates or benzodiazepines alone, polydrug users are more likely to be prescribed anti-depressants for depression or have a history of self-harm or suicidal ideation. Studies have indicated a high psychiatric comorbidity in cases of combination use, that include depression, anxiety, and emotional problems.
Social issues may develop as well as, these typically include:
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