Benzodiazepines significantly enhance the action of other Central Nervous System (CNS) depressant medications including methadone and buprenorphine. On their own, benzodiazepines have a broad safety profile but in combination with opioids in particular, the risk of sedation and respiratory depression increases significantly.
Patients with a history of addiction are at much higher risk for benzodiazepine misuse and dependence; therefore, benzodiazepines are not the ideal treatment for insomnia or anxiety in most cases. Tolerance to benzodiazepine-induced euphoria and sedation develops quickly, and withdrawal can be life threatening.
Abuse liability of specific benzodiazepines varies depending on pharmacokinetic properties, rate of absorption, metabolism, intrinsic activity and elimination half-life. There are few clinical situations where benzodiazepines may be appropriate for short-term use in methadone or buprenorphine treated patients. Despite the known increased risks of overdose and misuse, opioid dependent patients often access these prescriptions.
