Benzodiazepine Use Among Individuals with Opioid Use Disorder: A Narrative Review

Abstract

The concomitant use of benzodiazepines (BZDs) among individuals with opioid use disorder (OUD) is highly prevalent, with a rapid annual increase in overdose-related deaths. The co-use of BZDs is a significant predictor of opioid overdose. In the absence of other drugs, BZDs are rarely the sole cause of death. Prolonged BZD use frequently results in the rapid development of tolerance and dependence. A strong association has also been established between BZD misuse and depression. Moreover, chronic BZD exposure is linked to cognitive impairments, psychomotor disturbance, delirium, and an increased risk of falls, fractures, injuries, and traffic accidents. Outpatient clinicians should routinely screen for concurrent BZD use and exercise caution in prescribing. Timely interventions-including patient education, gradual discontinuation, psychological therapies, and skills-based training-are critical to mitigating harm and improving prognosis. In addition, Traditional Chinese Medicine(TCM), including herbal prescriptions and acupuncture, may serve as promising non-addictive alternatives for the management of anxiety, insomnia, and withdrawal-related symptoms. Strengthening multifaceted efforts will be crucial for reducing the burden of BZD use and improving treatment outcomes in OUD.