Effects Of Combining Sedatives & Opiates

  1. Effects of Benzodiazepines on the Brain
  2. What Happens When You Combine These Two Drugs?
  3. Why Do Some Users Combine Sedatives with Opiates?
  4. Treatment
  5. Associated Social and Mental Health Problems
  6. Sources

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.

Effects of Opiates on the Brain

  • 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.

Benzodiazepines can adversely affect brain function and precipitate psychological problems in extreme cases. If the effects of your benzodiazepine use have been getting worse, you need help. Our experienced treatment support staff can connect you with a program that's right for you. Please call 1-888-993-3112Ad Info & Options and get help today.


What Happens When You Combine These Two Drugs?

Opiate abuse can lead to:

  • Extreme drowsiness.
  • Suppressed hand and eye coordination.
  • Reasoning problems.
  • Confusion.

Similarly, abusing a sedative can result in:

  • Amnesia.
  • Serious fatigue.
  • Hypnosis.
  • Concentration problems.
  • Induced sleep.

As these two drugs can both be considered as depressants, combining them can slow bodily processes and brain activity potentially resulting in dangerously slow breathing, unconsciousness, or even death.

Combining these types of drugs may also cause the following:

  • Muscle weakness.
  • Decreased motor coordination.
  • Falls or other injuries.
  • Dizziness.
  • Fainting.

  • Somnolence.
  • Cardiac rate and rhythm irregularities.
  • Profound respiratory depression.
  • Death.

  • Studies on a combination of diazepam (a benzodiazepine) and buprenorphine (an opiate) also indicate that they have a negative impact on reaction times and cognitive functions.

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.

In fact, treatment admissions due to the co-abuse of benzodiazepines and depressants such as opiates or alcohol increased by more than 500% from 2000 to 2010, according to SAMHSA. Mixing benzodiazepines and opiates can be extremely harmful; please call 1-888-993-3112Ad Info & Options and get treatment today.

Deaths

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.

  1. Systemic issues in medical management. More specifically, the problem of “polypharmacy”—related to the co-prescription of both drugs, for example.
  2. 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.
  3. 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.

Treatment

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

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.

  • Sedative use or abuse among patients prescribed opiates may also be addressed by replacing benzodiazepines with other, less risky, drugs that are appropriate to their psychological state. These may include antidepressants or newer-generation antipsychotics.

Psychological

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.

Mixing opiate painkillers and sedatives has deleterious effects across physical and psychological domains. Getting the right therapy at the right time can mean the difference between recovery and chronic discomfort. If you are suffering, help is available; please call 1-888-993-3112Ad Info & Options and we will help you find a program that suits your needs.

Outpatient

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).

Inpatient

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

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

  • Research indicates that individuals who use benzodiazepines and opioids are at a higher risk for abusing other drugs—including alcohol.

    Specifically, they are more likely to have a diagnosis of alcohol or cocaine dependence.

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.

  • Some studies have also shown an increase in risky behaviors, such as needle sharing, that may exacerbate the risk of blood-borne diseases such as HIV although the correlation has not been significant in other studies.

Social issues may develop as well as, these typically include:

  • Forging drug prescriptions.
  • Stealing or asking others for pills.
  • Relationship problems.

  • Work or school absenteeism.
  • Financial problems.
  • Aggression


Sources

  1. Kosten TR, et al, “The neurobiology of opioid dependence: implications for treatment,” Science & Practice Perspectives, 1:13-20 (2002).
  2. Mendelson WB: Neuropharmacology of sleep induction by benzodiazepines. Neurobiology 16: 221, 1992.
  3. Amrein R, Hetzel W, Harmann D, et al: Clinical pharmacology of flumazenil. Eur J Anaesthesiol 2:65, 1988.
  4. Centers for Disease Control and Prevention (CDC). Drug overdose deaths--Florida, 2003-2009. MMWR Morb Mortal Wkly Rep. 2011; 60(26):869-72.
  5. Barker MJ, Greenwood KM, Jackson M, Crowe SF. Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Arch Clin Neuropsychol. 2004; 19(3):437-54.
  6. Fishbain DA, Cole B, Lewis J, et al. (2008) What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain Med 9: 444-459.
  7. Jann M, Kennedy WK, Lopez G. Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics. J Pharm Pract. 2014 Feb;27(1):5-16.
  8. Gudin JA, Mogali S, Jones JD, Comer SD. Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. Postgrad Med. 2013 Jul;125(4):115-30.
  9. Lintzeris N, Mitchell TB, Bond AJ, Nestor L, Strang J. Pharmacodynamics of diazepam co-administered with methadone or buprenorphine under high dose conditions in opioid dependent patients. Drug and alcohol dependence. 2007;91(2-3):187-194.
  10. Skurtveit S, Furu K, Bramness J, Selmer R, Tverdal A. Benzodiazepines predict use of opioids--a follow-up study of 17,074 men and women. Pain medicine (Malden, Mass.). 2010;11(6):805-814.
  11. Chen KW, Berger CC, Forde DP, D'Adamo C, Weintraub E, Gandhi D. Benzodiazepine use and misuse among patients in a methadone program. BMC psychiatry. 2011;11:90.
  12. National Institute on Drug Abuse. Monitoring the future survey, overview of the findings 2011. http://www.drugabuse.gov/related-topics/trends-statistics/monitoring-future/monitoring-future-survey-overview-findings-2011
  13. The TEDS Report: Admissions Reporting Benzodiazepine and Narcotic Pain Reliever Abuse at Treatment Entry. Rockville, MD: Center for Behavioral Health Statistics and Quality; 2012. Substance Abuse and Mental Health Services Administration (SAMHSA).
  14. Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug and alcohol dependence. 2012;125(1-2):8-18.
  15. Webster LR. Considering the risks of benzodiazepines and opioids together. Pain medicine (Malden, Mass.). 2010;11(6):801-802.
  16. Calcaterra S, Glanz J, Binswanger IA. National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999-2009. Drug Alcohol Depend. 2013 Aug 1; 131(3):263-70.
  17. Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013 Feb 20; 309(7):657-9.
  18. Saffier K, Colombo C, Brown D, Mundt MP, Fleming MF. Addiction Severity Index in a chronic pain sample receiving opioid therapy. Journal of substance abuse treatment. 2007;33(3):303-311.
  19. Hermos JA, Young MM, Gagnon DR, Fiore LD. Characterizations of long-term oxycodone/acetaminophen prescriptions in veteran patients. Arch Intern Med. 2004 Nov 22; 164(21):2361-6.
  20. Digiusto, E, et al, “Serious adverseevents in the Australian National Evaluation of Pahrmacotherapies for Opioid Dependence (NEPOD),” Addiction, 99:450-460 (2004).
  21. Ling, W, et al, “From research to the real world: Buprenorphine in the decade of the Clinical Trials Network,” Journal of Substance Abuse Treatment, 38:S53-S60 (2010).
  22. Pirnay, S, et al, “A critical review of the causes of death among post-mortem toxicological investigations : Analysis of 34 buprenorphine-associated and 35 methadone-associated deaths,” Addiction, 99:978-988 (2004).
  23. Durham, R.C., Chambers, J.A., Power, K.G., Sharp, D.M., Macdonald, R.R., Major, K.A., Dow, M.G., Gumley, A.I. (2005). Long-term outcome of cognitive behaviour therapy clinical trials in central Scotland. Health Technol Assess. 2005; 9(42):1-174.