Benzodiazepines and Opioids

Benzodiazepines and opioids are widely used in the medical field to treat various health conditions. Their use and effectiveness in managing certain health conditions have made them the treatment of choice among the thousands of healthcare providers in the U.S. and worldwide. According to the National Center for Health Statistics (NCHS), benzodiazepines, or benzos, are prescribed at about 66 million doctors’ appointments per year in the U.S., and according to the Centers for Disease Control and Prevention (CDC), around 153 million opioid prescriptions were dispensed in 2019 alone.

Benzos and opioids are both central nervous system depressants with a high potential for addiction and dependence. However, benzos and opioids fall into two entirely different classifications and are designed for different purposes. 

Difference Between Benzos and Opiates

Benzodiazepines, also known as mild tranquilizers, are central nervous system (CNS) depressants widely prescribed for various mental health conditions. They treat moderate to severe panic disorders, anxiety disorders, epileptic seizures, and withdrawal from other CNS depressants such as alcohol. 

Most benzodiazepines come in a pill or tablet form for oral consumption, although some brands are also available as a clear, odorless liquid to be administered intravenously. Benzodiazepines are highly regulated and considered the most prominent of all anti-anxiety medications for immediate relief. 

There are over 2000 different types of benzos available. However, only around 15 are currently approved for use by the  U.S. Food and Drug Administration (FDA). 

Some of the common types of benzos are: 

• Valium 
• Ativan 
• Klonopin 
• Librium 
• Halcion 

Opioids, also known as narcotics, are substances derived from opium, a natural chemical in poppy seeds and plants or synthesized in laboratories. They include the illegal substance heroin, synthetic opioids such as fentanyl, and prescription pain relievers such as oxycodone, hydrocodone, and codeine. Prescription opioids are used to treat mild to chronic pain and are also prescribed for pain management after surgery. Opioids are available as tablets, liquid, and film formations and are categorized as opioid antagonists and opioid agonists. 

Opioid antagonists are not addictive and include medications such as:

• Naltrexone 
• Naloxone 
• Nalorphine 

Opioid agonists are addictive and include medications such as:

• Methadone 
• Morphine 
• Codeine 
• Hydrocodone 

Opioid addiction remains a major health concern in the U.S. As a result, the opioid crisis was declared a “public health emergency” in 2017. 

Benzos Vs. Opiates – How Do They Work?

Benzodiazepines work by amplifying the effects of gamma-aminobutyric acid (GABA). GABA is a neurotransmitter responsible for reducing brain activity related to reasoning, memory, emotions, and essential functions, such as breathing. Hence, by enhancing this neurotransmitter, benzodiazepines help counteract overstimulation caused by anxiety and induce a state of relaxation. In addition, benzodiazepines are relatively fast-acting and can alleviate symptoms within a short period. 

In contrast, opioids work by attaching to the opioid receptors in the brain, gut, spinal cord, and other parts of the body. Thus, they help block pain messages sent from the body to the brain and, in turn, relieve both emotional and physical pain. Since most opioids activate opioid receptors, they can be highly habit-forming. However, opioid antagonists, on the other hand, occupy the opioid receptors without activating them, making them a treatment choice for alcohol use disorder (AUD) and opioid use disorder (OUD) that carries less risk of misuse and addiction. 

Side Effects of Benzodiazepines 

Benzodiazepines can cause side effects ranging from mild to severe. The side effects may differ from one person to another but generally include:

• Drowsiness 
• Light-headedness
• Confusion 
• Dizziness
• Slurred speech
• Muscle weakness 
• Memory loss
• Constipation 
• Nausea
• Dry Mouth 
• Blurred vision 

Some of the less common side effects of benzos include: 

• Headaches
• Low blood pressure
• Digestive problems 
• Rashes
• Tremors
• Changes in sexual desires
• Difficulty in urinating 
• Increased saliva production

Some of the rare side effects of benzodiazepines include:

• Blood disorders
• Jaundice (yellow skin)
• Gynecomastia (breast development in males)

It is crucial for people on this anti-anxiety medication to inform their health care professionals regarding any negative side effects to address them duly.

Side Effects of Opioids 

Medical professionals closely monitor people on opioid medications due to their ability to cause various side effects. Opioid side effects range from mild to severe and generally include:

• Sedation 
• Nausea
• Dizziness 
• Vomiting 
• Constipation 
• Dry mouth 
• Respiratory depression 

Some of the less common side effects of opioids are: 

• Delayed gastric emptying 
• Hyperalgesia (enhanced sensitivity to pain)
• Muscle rigidity 
• Myoclonus (sudden, brief twitching or jerking of the muscles) 
• Immunological and hormonal dysfunction 

Tolerance, addiction, and dependence are also a few other side effects of opioids. Prolonged use of opioids leads to tolerance and requires individuals to take more medication to achieve the desired effects. The formation of tolerance will gradually lead to physical dependence and addiction, even if the medication is used as prescribed. In addition, individuals with a dependence or addiction to opioids may experience withdrawal symptoms when they reduce or quit their use abruptly. Hence, it’s vital to seek the guidance of a health care provider before stopping them after prolonged use.

Benzodiazepine Withdrawal 

Like opioids, benzodiazepines can also trigger a withdrawal phase when their use is discontinued after a certain period. Benzodiazepine withdrawal can manifest after as little as one month of use. The onset of withdrawal depends on the specific type of benzo taken but may begin in as little as eight hours or within two to three days. 

Some of the symptoms of benzodiazepine withdrawal are:

• Insomnia
• Irritability
• Anxiety
• Restlessness
• Hand tremors
• Muscle spasms
• Headache
• Sweating
• Nausea
• Vomiting
• Hyperventilation
• Aches and pains
• Panic attacks
• Depression
• Racing pulse
• Hypersensitivity to stimuli such as light and touch
• Delirium tremens
• Grand mal seizures

Benzo withdrawal can be a difficult and potentially dangerous process. Therefore medical professionals wean people off these prescription medications through a gradual dose reduction. 

Opioid Withdrawal 

The severity and duration of opioid withdrawal are determined based on several factors: the duration of use, the frequency of use, and the doses taken. Opioid withdrawal symptoms range from mild to severe and may begin within 24 hours from the last dose. 

Some of the symptoms of opioid withdrawal include:

• Muscle aches
• Restlessness
• Anxiety 
• Runny nose
• Teary eyes
• Inability to sleep
• Diarrhea
• Abdominal cramps 
• Nausea
• Vomiting 
• Dilated pupils
• Rapid heartbeat
• High blood pressure 

Opioid withdrawal symptoms usually improve within 72 hours and reduce in intensity within a week. 

Benzodiazepine Overdose

In addition to the risk of misuse, withdrawal, and addiction, benzos can also increase the risk of overdose. An overdose occurs when an individual consumes large doses of benzodiazepines or mixes them with other substances such as alcohol to enhance its effects. 

Some of the symptoms of a benzodiazepine overdose are:

• Dizziness 
• Confusion 
• Drowsiness 
• Blurred vision 
• Slurred speech
• Unresponsiveness or weakness 
• Anxiety 
• Agitation 
• Breathing difficulties 
• Uncoordinated movements 
• Tremors
• Altered mental state 
• Mood Swings 
• Slowed Reflexes 
• Coma 

While the possibility of a benzo overdose is significantly low, so too is the risk of fatal consequences when taken alone. However, misusing benzos can cause serious health complications and should be used with caution.

Opioid Overdose

An opioid overdose transpires when an individual takes large quantities of an illicit opioid or an opioid pain reliever or mixes it with other substances. Opioid overdoses are fatal in most instances due to their effects on the brain region that regulates breathing. Hence, it’s vital to seek immediate medical attention when someone faces the following symptoms:

• Slow and irregular breathing 
• Slow heartbeat 
• Pale and clammy skin 
• Extreme drowsiness 
• Unconsciousness 
• Pinpoint pupils 
• Hypotension (Unusually low blood pressure)
• Hypoxia (lack of oxygen leading to brain damage, cardiac arrest, and death)

Overdose deaths related to opioids are a significant health concern in the modern world. According to the National Institute on Drug Abuse (NIDA), opioid-involved overdose deaths increased from 468,02 in 2018 to 49,860 in 2019. 

The Risk of Mixing Benzos and Opiates

There is an increasing trend in the number of people combining benzos and opioids for recreational purposes. Since both substances are easily accessible, some people tend to combine them to enhance the intoxicating effects of either of the substances. However, such a combination can be fatal, as both the substances are central nervous system depressants that suppress breathing. Combining them can depress breathing to dangerous levels and lead to a fatal overdose. According to the National Institute on Drug Abuse (NIDA), about 16% of opioid overdose deaths in 2019 also involved benzodiazepines.

Misusing both benzos and opioids over a prolonged period can also damage vital organs, memory loss, and cause brain damage. As such, the Centers for Disease Control and Prevention (CDC) issued new guidelines in 2016 recommending clinicians to avoid prescribing opioids and benzodiazepines concurrently whenever possible. 

While benzos and opioids are two different medications widely prescribed to treat various health conditions, their associated risks and health concerns must be acknowledged to avoid negative situations.

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