Opioid use disorder and concurrent benzodiazepine use: clinical risks and management strategies

Concurrent use of benzodiazepines (BZDs) and opioids in patients with opioid use disorder (OUD) is prevalent and poses significant clinical challenges, including increased risks of overdose, ER visits, and treatment discontinuation. This article synthesizes current evidence on the prevalence, risks, and management of BZD co-use in OUD, focusing on patients receiving medications for OUD (MOUD) such as buprenorphine and methadone. Data indicate that approximately 16-21% of patients on buprenorphine and up to 40-47% of those on methadone use BZDs, with nonmedical use linked to a significant increase in overdose-related emergency visits and overdose mortality (95% CI: 7.8-13.2). We propose an evidence-informed framework for managing co-use, prioritizing OUD stabilization, close monitoring and harm reduction, gradual BZD tapering, and integrated psychosocial interventions. This approach balances safety and efficacy, ensuring patient-centered care while mitigating risks.