A Deadly Mix: Opioids and ‘Benzos’

A Deadly Mix: Opioids and ‘Benzos’

Prescriptions for benzodiazepines have soared in the past decade, causing an alarming rise in overdose deaths when the tranquilizers are taken with opioid painkillers, according to a new study by Stanford researchers.

Benzodiazepine medication such as Xanax, Klonopin and Ativan  — also known as “benzos” – are used primarily to treat anxiety, mood disorders and insomnia. But they are being prescribed at greater rates than ever before and addicts are using them to enhance their highs.

Actor Philip Seymour Hoffman, who died last month from a drug overdose, had heroin, cocaine, benzodiazepines and amphetamines in his system, according to the New York medical examiner.

Researchers say the prescribing of benzodiazepines grew by 12.5% a year between 2002 and 2009. Patients being prescribed opioids were 4.2 more likely to also have simultaneous prescriptions of benzodiazepine. In fact, joint prescriptions of benzodiazepines and opioids increased by 12% a year.

Drug PoisoningThe combination turned up in nearly a third of the 16,651 overdose deaths in 2010 involving opioid painkillers, according to data from the U.S. Centers for Disease Control and Prevention.

“More research is needed to elucidate the reason behind the increase in benzodiazepine prescription, and a national effort is needed to highlight the danger of co-prescription of benzodiazepines and opioids,” said principal investigator Sean Mackey, MD, director of the Stanford Systems Neuroscience and Pain Lab.

Many pain patients are on an opioid/benzodiazepine regimen that can last for years.

“They are prominent fellow travelers with opioids,” Len Paulozzi, MD, a medical epidemiologist with the CDC told MedPage Today. “The problem is, people get on them and they stay on them forever.”

“As a complex, emotional experience, pain often is accompanied by significant alterations of mood, in particular anxiety,” said study co-author Ming-Chih Kao, MD, a clinical assistant professor at Stanford University Medical Center.

Kao says benzodiazepines are good medications to treat anxiety, but when taken with opioids there is a greater risk of depressing the central nervous system, which can lead to respiratory failure and death.

He called for better coordination between prescribers of opioids, who are often primary care physicians or pain specialists, with prescribers of benzodiazepines, who are often psychiatrists.

“The increased prescribing of benzos is directly related to the increased prescribing of opioids,” said Percy Menzies, president of Assisted Recovery Centers of America, in an email to National Pain Report.

Opioid addicts will often compartmentalize their symptoms, obtaining prescriptions for opioids from one doctor and prescriptions for benzos from other doctors. When patients test positive for benzos, they will admit that they need to benzos for their ‘panic’ attacks.”

Menzies says short-acting benzodiazepines, such as Xanax, Klonopin, and Ativan, have an abuse potential of their own.

“The relatively short ‘high’ is often used to mitigate the anxiety of withdrawal from opioids. Opioid addicts have attempted to combine the high from the opioids and the benzodiazepines, especially through IV use.”

The Stanford study was presented this week at the annual meeting of the American Academy of Pain Medicine.

Authored by: Pat Anson, Editor

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Brenda Smith

I have both and follow directions. Pain is still not adequately controlled. Dr should have rights to treat with out fear. Would love to leave bed, sleep, walk or go to store. Not addict, not criminal but in pain without fair treatment.


I am not an addict either. I’ve tried almost every pain med in the market for my auto immune disorders and nerve damage and rhumatoid arthritis. I always followed all directions and I have taken 1 mg to 2 mg at bedtime of Ativan for almost 20 yrs. I went off for 1-2 yrs at various times thinking I was an addict but the sleep clinic says I have an anxiety disorder that only appears to come out when I sleep. After trying numerous meds, gaining huge amounts of weight and finally going back to the few meds that worked - ativan and an opiate for pain - then I sleep and take the edge off the pain so that I can be around people and not bite their heads off. I am wanting to work part-time and my new pain doc is playing this addict b.s. talk to me and wanting to again take me off the low level opiate and telling me to “get moving” - which a-hem - I am moving - walking, water walking and low impact aerobics and yoga, doing trigger point injections (which don’t really work but makes doc happy) and also acupuncture and chiropractor which work a tad better and now finally starting to lose some of the weight I gained over the last year from thyroid storm and another “wonder” drug. Blah. Leave me on my old “faithful” meds that work. I count them out faithfully and have never filled them early with my pharmacy in all the years I’ve taken any medication or taken them outside of the given parameters. I wish they would include the pharmacists in these studies. They know who fills early or late or not at all, etc. I finally get a handle on my life only to have yet another doc try to screw it up again and treat me like crap. I relocated and I so miss my old doctors - they were loving and caring and I’m almost tempted to fly back to see them once a month if I could afford it. I had my neurologist, pain doc, psychiatrist, rhuematologist and primary and they all reported to my primary so that she could keep tabs on everything. That is how they taught me in the beginning to keep my primary doc in the middle of the circle always so that all docs reported to her. Learned this from both Mayo and Abbott Northwestern in MN. I’m so frustrated and another 8 months of meds screwed up and trying to prove myself to these “so-called” docs.

Denise Knox-Beckman

Having several conditions at once, but the major one was two back surgeries. The pain I experienced and saw to different pain mgmt doctors, I explained my symptoms, “it feels like a signal is sent up my spinal column, ( part of the CNS system) and then spasms that are crazy unreal and an explosion in the back of my head. ( these often left me with migraines, but didn’t associate the two till this year). Well, both said great job, both gave different meds, and both were very wrong. My fusion had failed surgery scheduled right away. I admit, light weight with heavy drugs! But hydrocodone from the first time I took it, I never had the “normal” side effects. I asked my pharmacists about it, 2% of the population is like me. Now, I ended up in a bed for years, drugs galore, weight gain crazy, uncontrolled blood pressure to the point of 5 different pills. After my third surgery, a now damaged leg, 4 more pain mgmt doctors, not one had a consistent treatment, and I put them in the “new way to make money category.” Sorry Pain Doctors, you wish to dish it out, then take it back. A study done quite some time ago by The New England Journal Of Medicine, stated those with “CHRONIC PAIN WERE LESS LIKELY TO ABUSE THEIR DRUGS AND TAKE AS NEEDED.” Now of course, you may have those few who become addicted, but for those who suffer, not so much. A person with detirmination and goals set of it took this long to put on it can take that long to take off, I reached my BMI, I took less pain medication, however clonidine needed for my leg as well as the max dose of gabapentin. I was active for years, could wear 5″ heels again, and felt a lot better. But I’ve always needed something to help me sleep, and twice a year I would get depressed. An accident on February 28, 2013, a death of my favored Uncle, then dealing with jerk dad, set off events that made my life spiral. I have Fibromyalgia never had Fog, got Fog day after funeral. I got home had a week break from school, and panic attack crazy began. Memories of a 32 year old lock up that door opened wide up! Military events, definitely PTSD. My body seemed fine, but slowly in the summer it got really worse and in the fall my pain medication increase as well. I also take Valuim up to 3 times a day, don’t always need them, so I would have to say, “hard pressed calling me an addict to either medications, because I control my intake of each!” Now, I am basically attached to my bed. Weekly visits at my local VA where I didn’t realize I was to service them, and not the other way around. Not only that, four different doctors who have four different thoughts, which the first one should… Read more »


Brian- I agree with you. I also was annoyed that pain specialists in the 2011, IOM report on pain care called all people in pain “catastrophizers” or that the AAPM along with the AMA in their pain summit repeated referred to pain care as a “burden”. Unless people in pain unite to change the views of pain specialists and government, people in pain will continue to be stigmatized and treated as burdensome catastrophizers.

Dennis Kinch

It is long past due to insist on separating patients, or “legitimate users” from addicts. They are 2 completely different things. This is not an opinion, but fact. How would they like it if every time the two were confused in a report, 50 million people would bring a class action lawsuit for defamation!

I’ve had almost every drug that Actor Philip Seymour Hoffman had in his system, but NEVER all at the same time. I had them at different times over many years under the care and supervision of a doctor…because I AM NOT an ADDICT!


It’s more than disappointing that the article, with an apparent quote from the study, refers to “Opioid addicts” and “patients” in the same paragraph, as if one is synonymous with the other. That sort of this is insulting, especially coming from medical professionals.