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Can You Take Benzodiazepines With Suboxone?

Both Suboxone and Xanax are sitting in your medicine cabinet. Can you take both medications at once? Your doctor can help you answer this question.

Benzodiazepines and Suboxone both work on the central nervous system and can cause respiratory suppression. Large doses taken together can slow your breathing and heart rate to dangerous levels.

Some people with mental health concerns do need both medications at the same time. Others must stop their use of one drug slowly and carefully before adding the other. Your doctor can help you manage the mix to make sure you are taking both medications safely.

What Are Benzodiazepines?

In the 1960s, researchers developed benzodiazepines to help people struggling with anxiety. Soon, doctors found other uses for these medications.

If you have an anxiety disorder or a seizure issue, your doctor might use benzodiazepines to soothe symptoms and help you feel better. But your doctor will likely watch your use carefully, as benzodiazepines have a high misuse potential.[1]

Benzodiazepines quiet electrical activity in the brain. For people with anxiety, the drugs help them to handle stress and strain. Others without an anxiety disorder may experience these things:

  • Euphoria
  • Deep relaxation
  • Feelings of self-worth
  • Emotional connection

All benzodiazepines work in this manner, but some have higher risks of misuse or diversion potential, according to drug-related law enforcement activity.[2]

Benzodiazepines cause persistent brain changes and dependence. Stopping them abruptly can sometimes be dangerous and cause withdrawal symptoms. If you do need to stop taking your benzodiazepine, your doctor can help you come up with a plan to taper your dose slowly.

What Is Suboxone?

For people with an opioid use disorder (OUD), Suboxone can provide life-changing results. This prescription medication eases cravings, lessen uncomfortable physical symptoms, and allow people to overcome addiction disorders.

More than 2.5 million Americans have an OUD. There were more than 28,000 overdose deaths in 2014.[3] Suboxone is an effective OUD therapy. With medication, you can lower your risk of opioid overdose.

Suboxone is a partial agonist of opioid receptors, which means it turns on opioid receptors in the brain just like other opioids, but not to the extent of "full-opioid" agonists, which means it has limited potential to cause extreme respiratory suppression and overdose.

Can You Mix Suboxone & Benzodiazepines?

Both Suboxone and benzodiazepines can slow down breathing and heart rates. They tend to augment one another, so mixing them can be potentially dangerous.

In 2019, 16 percent of overdose deaths attributed to opioids also involved concurrent use of benzodiazepines.[4] The risks are very real.

Some people may need to take both medications. If you have a seizure disorder, for example, you may need to keep taking your prescription while you add in Suboxone to help with an OUD. The harm caused by an untreated OUD might be greater than the potential harm caused by mixing these two medications.[5]

Therefore, the decision to take benzodiazepines and Suboxone together needs to be individualized on a case by case basis, in conjunction with a physician. This isn't a decision to make alone. Talk with your doctor about:

  • All the medications you take. If you see different professionals and they both write prescriptions, share your treatment plans with both doctors.
  • How much you take. If you use more than your doctor recommends, be upfront about that.
  • How you feel. If you are experiencing cravings, tell your doctor.

If you are taking benzodiazepines and you want to add Suboxone, don't stop your prescription abruptly. Talk with your doctor about the risks, whether you should taper, and how to taper.

SOURCES

  1. Kang M, Galuska M, Ghassemzadeh, S. StatPearls (Internet). StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482238/.2022. Accessed January 2022.
  2. Benzodiazepines. Department of Justice/Drug Enforcement Administration. https://www.dea.gov/sites/default/files/2020-06/Benzodiazepenes-2020_1.pdf. 2020. Accessed January2022.
  3. Effective Treatments for Opioid Addiction. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction. November 2016. Accessed January 2022.
  4. Benzodiazepines and Opioids. National Institute on Drug Abuse. https://www.drugabuse.gov/drug-topics/opioids/benzodiazepines-opioids. February 2021. Accessed January 2022.
  5. FDA Urges Caution About Withholding Opioid Addiction Medications From Patients Taking Benzodiazepines or CNS Depressants: Careful Medication Management Can Reduce Risks. U.S. Food and Drug Administration. https://www.fda.gov/media/107888/download. September 2017. Accessed January 2022.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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