The Deadly Risk of Mixing Benzos With Opioids

What Are These Drugs?

You might be familiar with the term speedballing, the practice of mixing uppers and downers in hopes of getting the best euphoric effects while canceling out the negative side effects. The most popular example of this is mixing the opioid drug heroin with the stimulant drug cocaine. Unfortunately, this comes with dangers often unknown until it’s too late. Instead of experiencing the best of both drugs, speedballing often results in users experiencing the negative side effects of both substances with greater intensity. This doesn’t only include negative feelings; it also includes the inability to breathe and think. 

While we might be tempted to think this only happens when different kinds of drugs work against each other in the body, this isn’t the case. Let’s take two drugs that are technically different (benzos and opioids) and think about how they work in the body. Benzos and opioids are indeed in different drug classes. This essentially means they are used for different purposes: benzos are regularly prescribed for things like anxiety, insomnia, seizures, and muscle relaxation, while opioids are regularly prescribed for moderate-to-severe pain and sometimes to suppress coughing or diarrhea. 

However, while these drugs are in different classes, benzos and opioids are the same types of drug, known as depressants or downers. Depressants do not mean these drugs cause depression, but rather these drugs depress or suppress the central nervous system. They do this by slowing down or manipulating the messaging between the brain and the body. In the case of benzos and opioids, it’s the messaging related to the things each of these drugs is trying to treat (anxiety, seizures, pain, cough, etc.). 

What’s the Danger?

The problem is neither of these drugs is guaranteed to work with pinpoint accuracy. While it might seem harmless to mix them because they are trying to treat different things, we have to keep in mind that mixing them can suppress the messaging between the brain and body to deadly levels. In fact, both of these drugs come with black box warnings from the U.S. Food and Drug Administration (FDA), meaning they carry a high potential for abuse and a dangerous list of side effects that could lead to overdose and/or death. 

When we read the FDA’s drug safety communication on benzos, it includes a warning that “abuse and misuse can result in overdose or death, especially when benzodiazepines are combined with other medicines, such as opioid pain relievers.” The document goes on to say that the reason for this risk is because it can result in depressing the central nervous system to the point that life-sustaining functions like breathing rates and heart rates drop to deadly levels. 

We might wonder how common this actually is. According to this 2020 FDA document release, 55% of benzo overdose deaths in the past five years occurred by mixing opioids. While we might be tempted to hope that this is now a downward trend, the past several years have seen the greatest opioid threat in history because of fentanyl’s rise. This opioid is far more potent than others in its class and has played a key role in the illicit drug industry. For the past several years, drug dealers have used the substance for drug cutting. This means that if someone on the street buys benzos, there’s a high chance that the benzo pills are cut with fentanyl.

Risk Management

It turns out that you don’t have to make the conscious decision to mix these drugs to actually do so. Maybe this is what makes the risk of mixing benzos and opioids so dangerous; it’s a danger that comes with the territory of using any drugs illicitly. Because of this, the safest path forward is to avoid all illicit drug use. However, if you find yourself dependent on benzos or opioids, this decision has the best chance of success with the dedicated help of addiction treatment professionals.