Benzodiazepines and opioid medications are used concomitantly in various circumstances, for example in anesthesiology, for the management of acute or chronic pain and for substitution therapy. Please note that many of the learning points and concerns regarding opioid therapy that have been presented in this tutorial also apply to benzodiazepines.

Opioid medications used in conjunction with benzodiazepine, such as Valium® or Xanax®, can result in increased side effects and can increase your risk of overdose and death. Always inform your physician of all the medications you are taking, especially benzodiazepines, while using opioid therapy.

Patients may be taking benzodiazepines for anxiety, muscle spasms, or sleep in addition to opioids to help manage their pain. It is important that patients using opioid medications try alternative options in place of benzodiazepines to treat the conditions mentioned above. You should also consider a consultation with a psychiatrist and/or sleep specialist to determine if there are safer options to effectively address issues with anxiety and insomnia. Just as with any medications, the lowest doses of benzodiazepines needed should be used, and all side effects should be reported to your physician.

The co-therapy of opioid and benzodiazepine medications has been safely used in many situations. Still, if this co-therapy is determined to be an appropriate option for you, you should always be under the supervision of a physician with extensive knowledge of these medications.

As with co-use of benzodiazepine and opioid therapy, the consumption of alcohol while undergoing opioid therapy also leads to an increased the risk of side effects and an increased risk over dose and death.

The combination of alcohol and opioids can be deadly, and leads to hundreds of accidental overdoses each year. Mixing alcohol with opioids causes severe respiratory problems, and can lead to cardiac arrest and a number of other health problems. If you take opioid medications regularly, you are at risk for dangerous drug interactions every time you have a drink.

We strongly recommend that patients do not consume alcohol while on opioid therapy. The excessive use of alcohol is an absolute contraindication to the use of opioid therapy. If you are consuming alcohol or feel that you have a drinking problem, please inform your physician immediately.

Patients often wonder if a small consumption of alcohol while on pain medications, such as a glass of wine with dinner, is safe. This is a difficult question to answer due to individual differences among patients. It is impossible to know in advance how much is “too much” alcohol. Concerning symptoms to watch out for include drowsiness, confusion, and/or dizziness. If you experience these side effects, seek medical care immediately. Again, we strongly recommend that you do not consume alcohol while taking opioid medications, or while you are taking benzodiazepines. Benzodiazepines combined with alcohol, with or without use of opioid medications, have similar serious concerns for overdose and death, and should be avoided.