Benzos are not opiates. Benzodiazepines such as Xanax, Klonopin, and Valium are sedatives that calm the brain through a different chemical system than opiates and other opioids use. Both drug groups slow the central nervous system, though, and the potential dangers of taking these drugs together include slowed breathing and death.
The confusion makes sense. Both classes include prescribed medications; both can lead to dependence and addiction, and both drugs appear often in overdose reports. Information about benzodiazepine addiction treatment in South Florida is available if benzo use has become hard to control.
Are Benzos Opiates?
Benzodiazepines are their own drug class. The Food and Drug Administration explains that they work by binding to gamma-aminobutyric acid (GABA) receptors in the brain, which slows brain activity and causes drowsy or calming effects [1]. Opiates and other opioids act on opioid receptors instead.
The FDA lists benzodiazepines approved to treat generalized anxiety disorder, insomnia, seizures, social phobia, and panic disorder. Common examples include alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), temazepam (Restoril), and triazolam (Halcion).
Both groups belong to the larger family of drugs that slow the central nervous system. Our guide to what are depressant drugs explains where benzos, opioids, and alcohol each fit.
Opiates Versus Opioids
The two words are often used interchangeably, but they are not quite the same. The Drug Enforcement Administration explains that natural opioids come from the opium poppy, semi-synthetic opioids such as heroin, oxycodone, and hydrocodone are made from those natural products, and synthetic opioids such as fentanyl and methadone are made entirely in a lab [2].
Opiates usually refer to the natural ones, such as morphine and codeine. Opioid is the broader term that covers all three groups. Benzodiazepines fit none of them.
Are Benzos Narcotics?
Prescription benzodiazepines are controlled sedatives, not narcotics under federal drug law. The legal definition of a narcotic drug includes opium-related substances and cocaine, so it is broader than the medical use of the word for opioids [3]. Benzos and opioids remain different drug classes.
How Benzos and Opioids Differ
These drugs overlap in some effects, but they are prescribed to patients for different reasons and act on the brain in different ways.
What They Treat
Doctors prescribe benzodiazepines mainly to treat anxiety, sleep disorders such as insomnia, seizures, and panic disorder, and as premedication before some medical procedures. Opioids are prescribed to treat pain, including some chronic pain, and to suppress cough.
In clinical use, the FDA asks physicians to weigh whether the benefits of prescribing a benzodiazepine outweigh the risks for each patient, considering the patient’s condition and the other medicines they take.
The FDA notes that most benzodiazepines are recommended for weeks or months, though the dose and duration vary by patient and condition. Benzos also differ from one another in how quickly they start working and how long their effects last.
How They Act on the Brain
Because they work through different receptors, the two classes affect brain functions differently. The DEA explains that, apart from pain relief and cough suppression, most central nervous system depressants have effects similar to opioids, including slowed breathing, tolerance, and dependence.
The differences show up in coordination and memory. The DEA notes that opioids usually do not cause slurred speech or loss of coordination except in extreme intoxication, while benzodiazepines and other sedatives can cause slurred speech, poor coordination, and memory impairment.
Common Side Effects
Benzodiazepines can cause drowsiness, dizziness, weakness, and slowed breathing. Breathing problems are especially concerning when they are combined with opioids, alcohol, or other sedatives. Opioids can cause constipation, nausea, pinpoint pupils, and itching, along with drowsiness and slowed breathing. At high doses, benzos can also cause confusion and memory loss for recent events.
Our post answering are opioids depressants explains how opioids slow the brain and body in more detail.
What Benzos and Opioids Have in Common
Both classes include prescription medicines that can lead to misuse and addiction, and both are routinely prescribed in the United States.
The FDA warns that even when benzodiazepines are taken at recommended doses, their use can lead to misuse, abuse, and addiction, and that physical dependence can develop when they are taken steadily for several days to weeks, even as prescribed.
Opioids carry the same risks of prescription drug misuse, and both drugs can be addictive. In both cases, tolerance can build, so the same dose may have less effect. Physical dependence and tolerance do not by themselves mean a person has an addiction; dose changes should be discussed with a prescriber.
The FDA says it cannot determine the likelihood that any one person will have serious side effects, since people respond differently depending on their health, genetics, and other medicines.
Withdrawal From Benzos and Opioids
Withdrawal differs between the two classes. The FDA warns that stopping benzodiazepines abruptly or lowering the dose too quickly can cause withdrawal reactions, including seizures, which can be life-threatening, and that some patients have withdrawal symptoms, such as anxiety, insomnia, and memory problems, lasting many months.
Opioid withdrawal brings its own symptoms, such as sweating, restlessness, nausea, cravings, and a rise in heart rate and blood pressure, which our post asking do opioids lower blood pressure explains. Anyone taking either drug regularly should talk with a doctor before stopping, rather than stopping benzos or opioids on their own.
Why Mixing Benzos and Opioids Is Dangerous
Combining these two drug classes can be especially dangerous. In 2016, the FDA added boxed warnings, its strongest warning, to both opioid pain and cough medicines and benzodiazepines, because combined use had led to slowed or difficult breathing and deaths [4].
The numbers show why. The FDA reports that benzodiazepine-involved overdose deaths rose from 1,298 in 2010 to 11,537 in 2017, and that 55 percent of those deaths from 2013 to 2017 also involved prescription opioids [1].
Breathing is what fails in these overdoses. Our post on respiratory depression explains how it develops and the warning signs to watch for.
What Research Shows About Benzos and Overdose
Research shows that benzodiazepines are a significant part of the opioid overdose epidemic. The FDA reports that in 2016, emergency department visits for nonmedical use of benzodiazepines, about 167,800, outnumbered those for nonmedical use of prescription opioids, about 129,900, and only 14 percent of the benzodiazepine visits involved benzos alone [1].
The serious harm usually comes from the combination, and many benzo-involved deaths are also opioid related deaths. The FDA’s review found that benzodiazepine misuse is common and that its harms occur primarily when benzos are used with other drugs, such as opioid analgesics, alcohol, or illicit drugs.
Benzos, Opioids, and Alcohol
The FDA also advises against drinking alcohol with benzodiazepines, because alcohol raises the risk of serious and life-threatening side effects. The same is true for opioids, and combining all three raises the danger further.
The FDA reports that 63 percent of 2017 poison center calls involving benzodiazepine misuse involved multiple substances, most often prescription opioids, alcohol, or stimulants, and that outcomes in those cases were more severe than with benzodiazepines alone [1].
Every alcoholic drink counts, including drinks with an energizing reputation, which our post on the tequila myth explains.
Benzos and Medications for Opioid Use Disorder
Some people in recovery take buprenorphine or methadone and also have a benzodiazepine prescription. The FDA advises health care professionals to take precautions when benzodiazepines are used with opioid addiction medications, and notes that careful medication management can reduce the risk of serious side effects.
The FDA has also cautioned against withholding treatment for opioid use disorder from people who take benzodiazepines. Telling every prescriber about each medication and any drug use helps them manage these risks in clinical care.
Signs of a Combined Overdose
The FDA advises calling 911 for trouble breathing or other serious side effects. Call right away if someone is extremely drowsy, cannot be woken, or is breathing slowly or not at all. Pinpoint pupils suggest opioids, but other signs of a benzo overdose, such as extreme drowsiness and slowed breathing, can look similar.
Give naloxone if an opioid overdose is possible and it is available, following the product instructions for repeat doses. It reverses opioid effects, but not benzodiazepines or alcohol. Follow the dispatcher’s instructions for rescue breathing or CPR, and do not wait for naloxone to work. Stay with the person; emergency care is still needed even if they wake up [5]. Some benzos stay active for a long time, which our post on how long do benzos stay in your system explains.
Frequently Asked Questions About Benzos and Opiates
Is Xanax an Opioid?
Xanax is not an opioid, since it is the brand name for alprazolam, a benzodiazepine that works through GABA receptors in the brain rather than opioid receptors. Xanax is prescribed for anxiety and panic disorder. Like opioids, it slows the central nervous system, so combining Xanax with opioids or alcohol can be dangerous.
Are Benzos More Addictive Than Opiates?
There is no simple ranking, because both can lead to dependence and addiction, even when taken as prescribed. Physical dependence on benzodiazepines can develop within days to weeks of steady use. The risk depends on the drug, the dose, how long it is taken, and a person’s history with other substances.
What Category of Drug Is a Benzo?
Benzodiazepines are sedative-hypnotics, a type of central nervous system depressant. They belong to the same broad depressant category as barbiturates and sleep medicines such as zolpidem (Ambien). They are not opioids or narcotics, though the two classes share risks such as slowed breathing, tolerance, and dependence.
Getting Information and Support
Knowing the difference between benzos and opiates can help you ask better questions about any medication you take. A doctor or pharmacist can explain whether your prescriptions are safe to take together, and treatment is available if either drug has become hard to stop.
The Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 is free and confidential, and anyone in a mental health or suicide crisis can call or text 988. For signs of overdose, call 911. Simple Path Recovery provides outpatient addiction treatment in Pompano Beach for adults.
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Do not stop or change a prescribed medication without talking to your prescriber. If you are in crisis, call or text 988; for signs of overdose, call 911.
Sources
- U.S. Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Drug Safety Communication, September 23, 2020 (content current as of October 2, 2020). https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class
- U.S. Drug Enforcement Administration. Narcotics (Opioids): Drug Fact Sheet. October 2022. https://www.getsmartaboutdrugs.gov/sites/default/files/2022-11/Narcotics%202022%20Drug%20Fact%20Sheet.pdf
- U.S. Code, 21 U.S.C. Section 802(17). Definition of narcotic drug. https://www.govinfo.gov/content/pkg/USCODE-2024-title21/html/USCODE-2024-title21-chap13-subchapI-partA-sec802.htm
- U.S. Food and Drug Administration. New Safety Measures Announced for Opioid Analgesics, Prescription Opioid Cough Products, and Benzodiazepines. August 31, 2016. https://www.fda.gov/drugs/food-and-drug-administration-overdose-prevention-framework/new-safety-measures-announced-opioid-analgesics-prescription-opioid-cough-products-and
- Centers for Disease Control and Prevention, NIOSH. Responding to a Suspected Opioid Overdose. https://www.cdc.gov/niosh/publications/numbered/2019-127.html
