When you take opioids and benzodiazepines together, you’re not just doubling down on sedation-you’re putting your breathing at serious risk. This isn’t theoretical. It’s happening every day in homes, clinics, and emergency rooms across the U.S. and the UK. The combination doesn’t just make you sleepy. It can shut down your lungs completely, even at doses that are considered safe when taken alone.
How These Drugs Work Together to Slow Your Breathing
Opioids like oxycodone, hydrocodone, and fentanyl work by binding to mu-opioid receptors in your brainstem-the part that controls automatic breathing. Benzodiazepines like alprazolam, lorazepam, and diazepam boost the effect of GABA, a calming neurotransmitter that also suppresses the brain’s drive to breathe. Individually, both drugs can slow breathing. Together, they don’t just add up-they multiply. Studies show that when taken at the same time, the risk of dangerously low oxygen levels jumps from 45% with opioids alone to 85% when benzodiazepines are added.This isn’t just about feeling drowsy. It’s about your body losing the ability to respond when carbon dioxide builds up in your blood. Normally, your brain senses this and tells you to breathe faster. With both drugs active, that signal gets muted. You might not even wake up when you stop breathing during sleep. That’s why many overdose deaths happen at night, when people are alone and unconscious.
The Numbers Don’t Lie
In 2020, nearly 1 in 6 opioid-related deaths in the U.S. involved benzodiazepines, according to the CDC. That’s about 220 people a day dying from opioid overdoses-and 16% of those deaths included a benzo. The risk of dying from an opioid overdose is three to eight times higher when benzodiazepines are also present. For patients taking both, the death rate is 10 times higher than for those taking opioids alone.Between 1999 and 2017, overdose deaths involving both drugs rose from 0.6 to 8.8 per 100,000 people. Even though rates have dipped slightly since then, they’re still far above where they started. A 2021 study found that 15% of Medicare patients on long-term opioids were also prescribed benzodiazepines-even though the FDA and CDC have warned against this for years.
Why Doctors Still Prescribe Both (And Why They Shouldn’t)
Some doctors still prescribe these drugs together because they think the patient needs pain relief and anxiety control. But the evidence shows this is rarely necessary. The FDA’s 2019 update made it clear: only prescribe both if no other options exist. Even then, start with the lowest possible dose of each and monitor closely.The problem is often inertia. A patient on long-term opioids for chronic pain may have been prescribed a benzodiazepine years ago for insomnia or anxiety. No one ever reviewed the combination. Or a patient gets a new prescription for anxiety after a surgery and doesn’t tell their pain doctor they’re already on an opioid. That’s how dangerous overlaps happen.
Older adults are especially vulnerable. The American Geriatrics Society lists this combination as potentially inappropriate for people over 65. Why? Because aging slows drug metabolism, increases sensitivity to sedatives, and raises fall risk-adding another layer of danger when breathing is already compromised.
What Happens When You Overdose on Both
An overdose from this combination doesn’t look like a movie. There’s no screaming. No thrashing. It’s quiet. The person becomes extremely drowsy, then unresponsive. Their breathing becomes shallow-maybe only 4 or 5 breaths per minute. Their lips turn blue. Their pulse slows. They may slump over in a chair or fall asleep and never wake up.Emergency responders call this “CNS depression.” It’s not just sedation. It’s respiratory arrest. Naloxone (Narcan) can reverse opioid effects, but it won’t fix the benzodiazepine part. That means even if you give Narcan and the person wakes up briefly, they can slip back into respiratory failure as the naloxone wears off and the benzo keeps working. That’s why patients who overdose on both need extended monitoring in a hospital-sometimes for 24 hours or more.
What to Do If You’re Taking Both
If you’re currently on both opioids and benzodiazepines, don’t stop suddenly. Withdrawal from either can be dangerous. Opioid withdrawal causes intense flu-like symptoms, anxiety, and insomnia. Benzodiazepine withdrawal can trigger seizures. Abruptly quitting either one can land you in the ER.Instead, talk to your doctor about a taper plan. This might mean slowly reducing the benzodiazepine dose over weeks or months while switching to non-addictive alternatives for anxiety or sleep-like CBT, melatonin, or certain antidepressants. For pain, consider non-opioid options like physical therapy, gabapentin, or topical treatments.
Ask your doctor: Is this combination absolutely necessary? If they say yes, make sure you understand the signs of overdose: extreme drowsiness, confusion, slow or shallow breathing, unresponsiveness. Give a trusted family member or friend a naloxone kit and teach them how to use it. Keep it in the same place as your medications.
How to Protect Yourself and Others
- Always tell every doctor you see what medications you’re taking-including over-the-counter drugs and supplements. Many people forget to mention sleep aids or anti-anxiety pills. - Use one pharmacy for all your prescriptions. Pharmacists can spot dangerous combinations before they happen. - Don’t mix with alcohol. Alcohol makes this interaction even worse. A single drink can push you into respiratory danger. - Never drive or operate machinery if you’re on both. Even if you feel fine, your reaction time and breathing control are impaired. - Ask about electronic alerts. Many hospitals and clinics now have systems that flag dangerous drug combinations when a prescription is written. Ask if yours does.What’s Changing in 2025
Health systems are getting better at preventing these combinations. In 2022, a study showed that adding clinical decision alerts in electronic health records cut dangerous co-prescribing by nearly 28%. More insurers are now requiring prior authorization before prescribing both drugs together. The CDC is funding new research to identify which patients are most at risk-and why.Meanwhile, new pain treatments are emerging that don’t depress breathing. Non-opioid nerve blockers, targeted physical therapy programs, and wearable neuromodulation devices are becoming more accessible. For anxiety, non-addictive medications like buspirone and prolonged psychotherapy are proving effective without the same risks.
The message is clear: opioids and benzodiazepines don’t belong together unless it’s a last resort-and even then, with extreme caution. Your life isn’t worth the risk of a quiet, unnoticed stop in breathing. If you’re on both, don’t wait for a crisis to act. Talk to your provider today.