The Risks of Combining Benzodiazepines and Suboxone

If you're being treated with Suboxone (buprenorphine/naloxone) for opioid use disorder, you may also be taking — or be prescribed — a benzodiazepine like Xanax, Valium, Klonopin, or Ativan for anxiety, panic, or sleep. It's important to understand that combining these two types of medication carries serious, well-documented risks.

Why this combination is dangerous

Buprenorphine (the active opioid component in Suboxone) and benzodiazepines are both central nervous system depressants. Individually, each can cause drowsiness and slowed breathing. Taken together, their effects don't just add up — they compound each other, significantly increasing the risk of profound sedation, dangerously slowed or stopped breathing (respiratory depression), coma, and death.

This risk is serious enough that the FDA requires a boxed warning — its strongest safety warning — on both opioid medications and benzodiazepines regarding concurrent use.

Warning signs of a dangerous interaction

If you or someone you know is taking both medications, seek emergency help immediately if you notice:

• Extreme drowsiness or difficulty staying awake
• Slow, shallow, or labored breathing
• Confusion or slurred speech
• Blue-tinged lips or fingertips
• Unresponsiveness or difficulty waking someone up

If you see any of these signs, call 911 immediately. If naloxone (Narcan) is available, administer it while waiting for emergency responders.

What to do if you're prescribed both

Sometimes a provider may determine that the benefits of a short-term, carefully monitored combination outweigh the risks for a specific patient — but this decision should never be made without a full picture of everything you're taking.

• Tell every provider you see about all medications you take, including benzodiazepines prescribed by someone else
• Never combine these medications without your prescribing provider's explicit knowledge and guidance
• Never adjust your own dose of either medication to compensate for the other
• Ask your provider whether a non-benzodiazepine option might be appropriate for your anxiety or sleep concerns
• Keep naloxone on hand if you or a household member takes opioids or benzodiazepines regularly

If you're currently taking both a benzodiazepine and Suboxone, or have questions about your medication regimen, talk to your Lighthouse provider — we're here to help you find a safer path forward.