Benzodiazepine and Methadone Considerations

safetyAnxiolytics are a frequently prescribed classification of drugs that are utilized to reduce anxiety and which may provide some anticonvulsant benefits for those at risk of seizure. The most common of this class are benzodiazepines such as Xanax, Ativan, Valium, Klonopin, or Librium. These medications have helped many people who suffer with generalized anxiety or panic disorder.

However, there is some consensus that benzodiazepines are over-prescribed. They are typically provided on a short-term basis only since tolerance & dependency can develop with prolonged use. Of particular concern to opioid treatment providers is the potential for fatal overdose when "benz" medications are taken in conjunction with methadone.

This is a delicate issue in that many methadone clinics have adopted a policy that disallows any use of benzodiazepines while a client is receiving methadone. This decision came about several years ago, as a safety measure, when a number of client deaths occurred tied specifically to benzodiazepine and methadone use combined.

It must be said that there are methadone patients who have received & taken benzodiazepine medication responsibly and experienced no problem. But the medical and addiction treatment community have recognized a significant risk associated with the mixture of these two potent medications. Ultimately, a program's physician is the one who bears responsibility for which medications can be safely administered. When benzodiazepines are determined to be "too risky", this can leave a methadone patient feeling defenseless & concerned about their ability to manage their chronic anxiety. No doubt, unmanaged co-occurring disorders (and uncomfortable associated symptoms) can put clients at increased risk of drug relapse.

It is very important that treatment providers (opioid programs) give their clients ample support & alternative options for coping with their anxiety. There are non-addictive medications-of-choice for treating anxiety such as Buspar, and also a variety of cognitive-behavioral approaches that help clients learn to moderate their anxiety symptoms using newly developed skills.

In the end, opioid program clients put their trust in the expertise of the clinic physicians & staff who aim to help them. Sometimes, there is no perfect answer. And clinic staff must base a treatment decision on maximum client safety as well as factoring in liability concerns that could even jeopardize the clinic's existence. Benzodiazepines will remain a high priority topic for some time to come. They too, like methadone, are helpful medications. They too, like methadone, must be closely monitored and used appropriately.