Benzodiazepines vs. Narcotics (Opioids)

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Facts on benzodiazepines vs. narcotics (opioids)

What are benzodiazepines? What are narcotics (opioids)?

Benzodiazepines are central nervous system depressants that cause sedation and are used to treat anxiety and panic disorders, muscle spasms, insomnia, nervousness, seizures, alcohol withdrawal, premenstrual syndrome, status epilepticus, and as sedation during surgery. Benzodiazepines are believed to work by increasing the effects of a neurotransmitter in the brain called gamma-aminobutyric acid (GABA). GABA reduces the activity of nerves in the brain that may cause seizures, anxiety, and other conditions.

Narcotic (opioid) analgesics are used to treat moderate to severe pain. Narcotics attach to receptors on nerves in the brain that increase the threshold to pain and reduce the perception of pain. Most people take narcotics for short-periods of time until pain lessens or goes away. Chronic pain requires a pain management plan since long-term use of opioids can lead to drug addiction and tolerance. Narcotics (opioids) have a high potential for misuse, abuse, and diversion.

What are the side effects of benzodiazepines and opioids?

Benzodiazepines

Common side effects include:

  • Lightheadedness
  • Drowsiness
  • Confusion
  • Sedation
  • Memory impairment
  • Improper body balance
  • Increase or decrease in appetite
  • Nausea
  • Vomiting
  • Constipation
  • Weight gain
  • Dry mouth
  • Reduced libido
  • Fatigue

Serious side effects include:

Narcotics

Common side effects of narcotic analgesics include:

Severe side effects of narcotic analgesics include:

What drugs interact with benzodiazepines and opioids?

Is it OK to drink alcohol or take similar drugs to benzodiazepines together (drug interactions)?

No. Combining alcohol with a benzodiazepine is very dangerous. People who drink alcohol while taking this medicine will feel the effects of alcohol faster. It's not safe to drink alcohol or take other drugs that have similar effects on the central nervous system (CNS) at the same time because these drugs or substances interact with oral benzodiazepines by causing additional depression of the brain and respiratory depression. Respiratory depression can lead to breathing that's inadequate for supplying oxygen to the body. This can cause death. Examples of these drugs and products that increase sedative side effects or the risk of respiratory depression from benzodiazepines include:

Pain medications called opioids that also cause respiratory depression, for example:

Sedatives (for example, insomnia medicine) and other medicine that cause sedation, for example:

What drugs interact with narcotic pain medications (opioids, analgesics)?

Narcotic analgesics should not be used with the following drugs such as monoamine oxidase inhibitors or MAOIs because of severe reactions that can be fatal.

Therefore, the discontinuation and initiation of narcotic analgesics and MAO inhibitors should be separated by at least 14 days.

Narcotic analgesics should be used with caution with central nervous system depressant medications such as alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), zolpidem (Ambien), zaleplon (Sonata) and alcohol because of increased risks of respiratory depression, low blood pressure, sedation, and in severe cases, coma and death.

Narcotic analgesics should be used with caution with medications that alter liver enzymes that affect the elimination of narcotic analgesics because levels of narcotic analgesics can increase or decrease in the body and thereby affect their therapeutic effectiveness.

Can I get addicted to benzodiazepines and opioids?

Benzodiazepines

Benzodiazepines or benzos are habit forming and you can become addicted to them - even if you take them as your doctor or health care professional has prescribed. People who have a history of drug or alcohol abuse are more likely to develop an addiction to these drugs. If you use these drugs over a long period of time you can develop a tolerance for them. This means that you will need higher doses of the drug to treat your health condition or disease because you've become tolerant of the weaker formulations of the drug. These drugs may be very effective for the treatment of several conditions, for example, anxiety and insomnia; but be careful because you can become addicted to them.

The street names for benzodiazepine drugs are "Benzos" and "Downers." Drug addicts abuse these drugs to get "high." They can cause addiction similar to opioids (narcotic drugs like oxycodone, morphine, hydrocodone, and fentanyl), cannabinoids (marijuana), and the club drug GHB (gamma-hydroxybutyrate).

They are commonly abused by young adolescents and young adults who crush it up and snort it, or take the tablet to get high. If you abuse this medication you may have adverse effects with symptoms include:

  • Disturbing or vivid dreams
  • Irritability
  • Hostility
  • Amnesia

Signs and symptoms that you might be addicted include:

  • Problems sleeping
  • Diarrhea
  • Vomiting
  • Nausea
  • Goose bumps
  • Uncontrollable leg movements
  • Bone and muscle pain

It is very difficult to recover from benzodiazepine addiction because these drugs change the chemistry of the brain. Contact a drug addiction treatment center if you or a loved one are suffering from a addiction. Quitting cold turkey is not likely to be successful and can be dangerous because of symptoms of withdrawal. Doctors and other health care professionals that treat addiction will formulate a taper schedule to slowly wean off the medication to reduce the severity of withdrawal symptoms during treatment.

Signs and symptoms of overdose include:

  • Clammy skin
  • Dilated pupils
  • Rapid and weak pulse
  • Coma
  • Shallow breathing
  • Death

Opioids

Most men and women take narcotic analgesics for short-periods of time until pain lessens or goes away. Some adults have chronic pain, which requires proper pain management since long term use can lead to drug addiction and tolerance (the need for increasing doses). Narcotic analgesics have a high potential for misuse, abuse, and diversion (to addicted persons).

The CDC developed and published the CDC Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings in 2016.

Drug addiction puts its sufferers at risk for potentially devastating social, occupational, and medical complications. Effects of chemical dependency on families include increased risk of domestic violence. Individuals with drug use disorder are also much less likely to find and keep a job compared to people who are not drug addicted. Children of parents with a substance use disorder are at higher risk for impaired social, educational, and health functioning, as well as being at higher risk for using drugs themselves.

In addition to the many devastating social and occupational complications of drug addiction, there are many potential medical complications, including respiratory arrest associated with heroin or sedative overdose.

What are the different types of benzodiazepines and opioids?

Benzodiazepines

Examples of oral benzodiazepines are:

Formulations of benzodiazepines

All oral benzodiazepines are available in tablet forms.

  • Alprazolam and clorazepate are available as extended-release tablets.
  • Alprazolam, clobazam, diazepam, and lorazepam are available in oral liquid form.
  • Alprazolam and clonazepam are available in orally dissolving tablets.
  • Chlordiazepoxide, oxazepam, and temazepam are available in capsule form.
  • Diazepam also is available as a rectal gel.
  • Some benzodiazepines are available for injection.

Opioids

  • Codeine, oxycodone, hydromorphone, and methadone are available as immediate-release tablets.
  • Oxycodone and morphine are available as extended-release tablets.
  • Morphine and hydrocodone are available as extended-release capsules.
  • Morphine also is available as intravenous, subcutaneous, and intramuscular injections.
  • Fentanyl is available as an oral lozenge (Actiq) and topical patch (Duragesic).

Are benzodiazepines and opioids safe to take while pregnant or breastfeeding?

Benzodiazepines

  • The FDA classifies benzodiazepines as pregnancy category D, which means that benzodiazepines can potentially cause fetal harm if administered to pregnant women. If benzodiazepines have to be used in pregnant women or if the patient may become pregnant while taking benzodiazepines, the patients must be informed of potential risks to the fetus.
  • Benzodiazepines enter breast milk and can cause lethargy and weight loss in the newborn. Therefore, they should not be used in nursing mothers.

Opioids

  • Opioid use is not safe for use in pregnant women. Narcotic analgesics may pass through breast milk and affect the baby; therefore, they should be avoided in females who are breastfeeding.

Summary

Benzodiazepines are central nervous system depressants that cause drowsiness and are used to treat insomnia, seizures, anxiety disorders, nervousness, panic disorders, muscle spasms, alcohol withdrawal, status epilepticus, premenstrual syndrome, and as sedation during surgery. Narcotic (opioid) analgesics are used to treat moderate to severe pain. Both benzodiazepines and narcotics (opioids) are common drugs of abuse.

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Medically Reviewed on 8/16/2018
References
REFERENCES:

FDA Predcribing Information

DEA Factsheet on Benzodiazepines https://www.dea.gov/factsheets/benzodiazepines

https://www.drugabuse.gov/drugs-abuse/opioids
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