Benzodiazepines and “Z-Drugs” Increase Death Risk When Taken With Opioids

Opioid Prescription Pill Overdose

A new study by Vanderbilt University Medical Center researchers of more the 400,000 Medicare patients taking medications for insomnia found that the risk of death is increased when either benzodiazepines or “z-drugs” are taken with opioids.

The study, published on July 15, 2021, in PLOS Medicine and led by Wayne Ray, PhD, professor of Health Policy at VUMC, compared patients taking these drugs with opioids to comparable patients taking trazodone, another commonly prescribed sleep medication for older patients. The researchers found that those using benzodiazepines had a 221% increase in the risk of death from any cause and those taking non-benzodiazepine hypnotics, or “z-drugs,” had a 68% increased risk.

“Our findings indicate that the risks of benzodiazepine-opioid use go well beyond the recognized hazards of overdose. They also suggest that the z-drugs, thought to have better safety than the benzodiazepines, in fact are dangerous when prescribed in combination with opioid pain medications,” Ray said.

Benzodiazepines, including brand names such as Restoril, Ativan, and Halcion and the “z-drugs,” a type of medication known more commonly under names like Ambien, Lunesta and Sonata, are among the most frequently prescribed medications for older adults.

Trazodone, a medication initially introduced for depression, is often prescribed in low doses for insomnia. Although researchers have speculated about the relative safety of these sleep medications, there is limited relative safety data.

Ray said the study findings could help to fill this data gap and thus lead to changes in both provider behavior and policy.

“Our findings add urgency to efforts to limit concurrent prescribing of benzodiazepines and opioids. They also suggest that targeted warnings are needed to advise older patients and their providers regarding the potential risks of taking z-drugs with opioids,” Ray said.

Reference: “Mortality and concurrent use of opioids and hypnotics in older patients: A retrospective cohort study” by Wayne A. Ray, Cecilia P. Chung, Katherine T. Murray, Beth A. Malow, James R. Daugherty and C. Michael Stein, 15 July 2021, PLOS Medicine.
DOI: 10.1371/journal.pmed.1003709

The study was supported by a grant from the National Heart, Lung and Blood Institute.

5 Comments on "Benzodiazepines and “Z-Drugs” Increase Death Risk When Taken With Opioids"

  1. William Martin Readling | July 16, 2021 at 12:09 pm | Reply

    Not surprising. Both classes of drugs reduce respiration, and depress central nervous system activity.

  2. As one who took a 50mg Tramadol daily for Arthritis, bulging disc pain and sciatica, then a 2mg Ativan each evening, and then an Ambien 10mg at bedtime,(for 10 yrs orlonger)and had pain and Anxiety relief and excellent sleep, I would testify that there was no risk of overdose, but greatly increased quality of life, until I moved and a frightened MD decided I had to be removed from this med routine, and make me suffer, as these meds were prescribed for conditions that have continued untreated, because of the drug abuses of others who overdosed using non prescribed drugs or some tainted with Fentanyl. The many who took prescribed Benzos,pain meds and sleeping meds without any abuse, addiction, or respiratory depression, should be included in any reporting of how dangerous it is. We are overlooked, and there were many of us, now deprived of previously available treatment.

  3. Jeannette Price | July 18, 2021 at 11:34 am | Reply

    I have taken them together for 15 years. Never have I come close to an overdose. I have been repeatedly abused by the medical community because of my medication. Why the fear and prejudice. Talk to people who have been on them. This is definitely a fake article. This piece definitely comes from a place of ignorance. Prop is pushing this crap and you feed it to the public. I use to have quality of life. Educate yourself.

  4. Because of misleading articles such as this, I have been denied treatment for chronic anxiety I have had all of my adult life. I visit pain mgmt every month for my opioids, but am allowed SIX .5 mg lorazepam per MONTH. That is NOT treating my anxiety. It is driving me to want alcohol, which will result in me losing my pain meds, which WILL LEAD TO MY SUICIDE.

  5. L Lee Taylor | July 23, 2021 at 12:11 pm | Reply

    What utter and complete nonsense! I’ve taken both with a powerful muscle relaxant for 30 years! You people have no idea how severe anxiety effects every aspect of a person’s life just like you have no idea how medications work in tandem. There is risk involved in everything like crossing the street puts me at risk of being hit by a car. According to you people I should never cross the street to eleminate the risk of being hit by a car. How do you sleep at night knowing the suffering you inflict on people? Why don’t you ever ask the people like me who have had long term experience with these combinations of medication? You won’t because you have 0 interest in the FACTS! STOP INTERFEARING WITH MY MEDICAL CARE!

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