For many years, care providers avoided prescribing popular medications for opioid use disorder (MOUD) to people who take benzodiazepines (benzos for short). Benzos treat anxiety, which can contribute to opioid use. Suboxone is the gold-standard MOUD. Methadone is another example. Both types of drugs can cause central nervous system (CNS) depression. This is when a person’s breathing slows or stops. Taking them together can increase your risk of this happening. The Food and Drug Administration (FDA) first issued a warning about this hazard in 2016.
Substance use disorder (SUD) goes hand in hand with mental health conditions — 33% of adults in the United States who have a mental health condition also have SUD, according to the 2023 National Survey on Drug Use and Health. Many people with anxiety and opioid use disorder (OUD) are already taking benzos with opioids when they begin treatment. They might have a prescription for diazepam (Valium), for example, and use heroin. Compared to purer forms of opioids, MOUD pose a much lower risk. These are highly regulated medications prescribed by a doctor. Starting treatment with MOUD would be safer in most cases. However, until recently, care providers couldn’t take on the liability. Fortunately, the FDA has changed its stance on this issue since 2016.
There are many reasons why people take benzos, opioids, and MOUD. These drugs can also have both positive and negative effects that change over time. Living without anxiety medication can make it very hard to stay on track with recovery goals. Doctors are better able to help people manage the risk of taking these medications together. More of them are willing to prescribe Suboxone for people who take diazepam.
In this blog post, we’ll talk about the risks and benefits of taking Suboxone and diazepam or other benzodiazepines together and when it’s OK to do so.
Can you take Suboxone and diazepam or benzodiazepines together?
There is a slight risk of unwanted effects when taking Suboxone with benzos. There have been cases of respiratory depression. This is more common among people who don’t have OUD. It’s generally safe under a doctor’s supervision. Suboxone has a lower risk of breathing issues and overdose than other MOUD. People in treatment also work closely with a care provider who manages their dosage.
The FDA still requires a boxed warning about the risks of combining benzos and MOUD. The warning was revised to include more guidance. In 2017, the FDA issued another statement to urge caution about refusing MOUD for people taking benzos, reasoning that “the harm caused by untreated opioid addiction can outweigh [the] risks.” When these people don’t receive treatment, they’re no less likely to continue using opioids with benzos. The statement emphasizes that you can reduce these risks by working with a doctor who has proper DEA registration.
What are the risks of taking Suboxone and diazepam or benzos together?
Taking too much Suboxone with benzos can cause symptoms similar to opioid intoxication or overdose. People may lose consciousness, have difficulty breathing, or stop breathing altogether. This is because both types of drugs depress the central nervous system (CNS). People may also have a slower reaction time or impaired motor skills when taking these medications. You should monitor how you feel and practice extreme caution when driving or using heavy machinery. If you’re at all sleepy, tired, or moving more slowly than usual, it’s best not to drive.
Suboxone and benzos are not the only types of drugs that cause CNS depression. People should avoid drinking alcohol when taking these medications. Alcohol can also have interactions with prescription opioids, and certain antipsychotics, muscle relaxants, sleep aids, and tranquilizers.
When a person has trouble breathing or loses consciousness from this combination, Narcan (naloxone) won’t reverse these symptoms. It doesn’t have any effect on slowed breathing from benzos, alcohol, or other types of drugs.
If you notice any of the following symptoms in a loved one taking Suboxone with benzos, seek emergency medical care right away:
- Extreme sleepiness
- Loss of consciousness or awareness
- Confusion or delirium
- Unresponsiveness
- Slowed or difficult breathing
- Blue lips or skin
What are my alternatives to continuing diazepam while taking Suboxone?
Some treatment providers are hesitant to prescribe Suboxone to people taking diazepam. They may encourage you to stop taking your anxiety medication or try to stop using opioids without MOUD. In our experience, this only discourages people from pursuing their recovery. We try to help our members understand the risks and benefits of each option so we can make the best choice together.
There are many other anxiety medications that are safer to take with Suboxone. The problem is that most people don’t want to delay treatment long enough to make the transition. It can take some time to find anxiety medication that works. When compared with the risk of opioid overdose, many people would rather stick with their anxiety meds during treatment. Compared to other MOUD, Suboxone is a safer and more effective option.
Suboxone doesn’t cause as much sedation or respiratory depression as methadone. That’s because the main ingredient in Suboxone, buprenorphine, is a long-acting partial opioid agonist that has a “ceiling effect.” It binds to opioids better than full agonists and the effect of respiratory depression doesn’t increase with higher dosage. Other medications for opioid use disorder like methadone are full opioid agonists. Suboxone doesn’t make you feel “high” if you already have a high tolerance for stronger opioids. In fact, it reduces your ability to get high from any type of opioid. It helps prevent withdrawal symptoms and cravings.
It can take some time to adjust to Suboxone and find the dosage that works best for you. You should always take Suboxone exactly as prescribed. Taking Suboxone improperly can lead to tooth decay and oral infections. Follow your doctor’s instructions and avoid brushing your teeth for an hour after taking it.
Where can I get safe Suboxone treatment if I’m taking benzos?
Many outpatient clinics like Groups offer medication management for people who want to start their recovery while taking benzos. Each clinic works a bit differently and they have their own unique expectations.
Your primary care doctor, psychiatrist, or other care provider can prescribe Suboxone. They just need the credentials to prescribe Schedule III medications. However, it may be best to work with someone who specializes in treatment for OUD. If you’re working with more than one care provider, you can usually sign a release form that allows them to share information. This can help ensure that your treatments don’t conflict with each other.
Groups can safely manage Suboxone treatment for people taking benzos
At Groups, each of our members gets personalized treatment through a provider and a licensed counselor. Your care team can help you explore your options and determine if Suboxone is right for you. You can also give and receive support with peers during group sessions. Suboxone treatment, counseling, and group support make up our approach to OUD recovery.
Our goal is to provide treatments that support the life you want to live. We know that deciding what’s best for you is a complex process with many variables. Building a trusting relationship with your care providers is critical for your success. We don’t punish people or kick them out of our program for using opioids. This helps encourage honesty so we can have deeper, more productive conversations.
Are you looking for a recovery clinic that will listen to your concerns? We can help. Give our Recovery Support Specialists a call today for more information. Let’s talk about your recovery goals and create your unique plan. If Groups doesn’t offer treatment in your state, you can locate other treatment options here.
