Benzos How to quantitatively estimate magnitude of interaction between benzos and opiates? Web pages just give scaremongering

[lalalamort]

Hi all,

I’ve struggled to find any answers this question by conventional means as all I get is scaremongering: How much do benzos and opiates interact? I know that they do and all the information is “Don’t do this”…but what about for low doses. Is the interaction of the type that one just combines the CNS depressing effects of both, or is there a real interaction where both together is more than twice of one on their own? Would taking like 60mg of codeine with 5mg of diazepam (Valium) be safe for someone with no tolerance? I would think so, assuming there isn’t a crazy interaction…its just hard to get quantitative estimates of the interaction as all websites just so “DON’T DO THIS’. Any suggestions for resources to find more info or personal experiences?

Cheers.

 

[BridgeInspector]

The interaction is just combined CNS depression AFAIK. You get more respiratory depression from say 20mg valium and 100mg codeine than just like 200mg codeine. They don't potentiate each other by increasing absorption or metabolism.

Taking benzos and opioids can be done without dying. Doctors do it, but obviously they monitor symptoms etc. And it's harder to do it safely in a recreational context.

60mg codeine and 5mg valium would likely be safe for a non-tolerant person. People generally advise against these kind of combinations because its hard to know for sure. It's kind of unpredictable and there isn't an exact science to it. 2+2 might equal 4 or it might equal 6, depending on the person.

The harm reduction advice for these things is generally to start as low as possible to gauge the effects. Like 30% of your usual dose.

I've taken depressant combinations a fair few times, often recklessly. Before I knew the risks I drank a lot on benzos and it always resulted in blackouts. With opioids and benzos/alcohol I always noticed my breathing slowing down way more than usual which kinda freaked me out so I just try and avoid that combo.

 

[BridgeInspector]

Part of the reason why the blanket advice is almost always "don't do this" is precisely because it's so hard to quantify or predict the extent of the synergy, imo. As @BridgeInspector pointed out, it's not really 2+2=4, it's 2+2= 4, 5, 6, 7, 8, whatever.
I've also mixed opes and benzos a fair amount of times (and carisoprodol, too; the 'holy trinity' as it's known)... the only time I've had to be revived by paramedics was when I mixed vaporized brorphine and deschloroetizolam.

There's another factor that doesn't always get sufficient attention; benzos impede rational decision making, just like alcohol, and this can lead to reckless redosing that leads to overdose. That's what happened to me; the benzo anxiolysis led to me vaping WAY more brorphine than I otherwise would have, and removed the anxiety I would have normally felt about how depressed my respiration was. Because of this, I blew-off taking naloxone; "I'll be fine, no worries!" *ODs*.

Imo, good harm-reduction practice for mixing opes and GABAergics is to avoid redosing either, and, as has been stated, reducing your doses of both. The synergy can be unpredictable, and can have a dose-response curve that differs from what you're used to using either substance alone. The alterations to the DRC are, I suspect, a contributing factor to benzo/ope ODs.

Lots of people find they mix well, but I've also found it really increases the addiction potential; that synergizes too.

In summation, it's my opinion that you gotta watch out for: respiratory depression, increased potential for psychological addiction, an altered dose-response curve, a narrower therapeutic index (the diff between an effective dose and a lethal dose), and impaired decision-making that leads to bad judgment calls. It's not just the increased respiratory depression.

Combine all those factors, and you get the reason why most sources advise against it; it requires a delicate balance, and should definitely be worked up to vs diving in headfirst. Lots of people aren't familiar enough with drugs to pull off that balancing act, and fatal opioid overdoses from non-IV RoAs often involve benzos because of people not knowing how to safely manage the combo.

Tbh I don't really think of it as scaremongering; it's incorrect to say it is always a life-threatening danger, but it would also be incorrect to say that it's nothing to worry about. Lots of non-BL users know very little about the drugs they take or the way that those drugs work, and if we think back to when we first started using, we may not have intuitively known that mixing two drugs from different classes could be more readily fatal than taking them separately.

Shit, the number of friends I've had to warn about not mixing alcohol and GHB, for example, is sort of depressing. And the number of people who intentionally or unintentionally killed themselves mixing alcohol and barbs lends credence to the idea that caution and going low 'n slow is a prerequisite to mixing potent CNS depressants.

But yeah obvi it's not the "IT WILL INVARIABLY KILL YOU" shrick some sources claim, given that some people are prescribed both opioids and benzos concurrently. But given how often non-IV ope ODs involve benzos, it defo demands caution

You're definitely right about the disinhibition. On some of my more reckless combos I hadn't planned ahead, it was just a case of "monkey brain feel good, give more now" so I popped whatever else was available.

And yeah combos are addictive in their own right. I don't even wanna take benzos without booze anymore and even if I set out to take the benzos alone I'll soon find myself scouring the house for cooking wine or a forgotten bottle of something.

 

[Lorne???]

Start with half of the usual dose of each, and doing not redose until the duration of action has worn off

I know people who were RXed 90mg Methadone and 3mg Klonopin per day, and I was prescribed 8mg clonazepam (Klonopin) per day and mixed it with opipids daily

However I am an experienced user with a high tolerance, an IV h/IM habit, and nearly 15 years experience

Though no, it is not the instant fatality some claim, and the danger of mixing safe doses is FAR OVERSTATED, yet it should always be approached with caution

10mg Valium amd no more than 100mg Codeine should be safe with no redoing for 8 hours; you may want to start with 80mg Codeine to be safe

Luckily Valium is very mild and has a very short duration of action, and Codeine is pretty lightweight, so I would not call this a dangerous combo unless you take a quarter gram Codeine and pop multiple Valium

Just be careful and use common sense and you shall be fine

 

[BridgeInspector]

I think you really hit the nail on the head with the "not wanting to do [x drug] without benzos/benzos without [x]"... it sort of makes taking that thing w/o benzos feel inferior by comparison. Like, it's hard to go back to that benzo or other drug in isolation; which is a shame. And it's not even that it necessarily feels great, or anything, it just seems to trigger a drug-seeking complex/activates the reward system to a greater extent.

I too start searching out the Juice/other drugs while benz'd, and turn into Pauley Polydrug + smash that (endorphin) subscribe button until I run out of drugs or pass the fuck out. I can't really think of an instance in which I took benzos and made better decisions than I would have had I been sober, and it also pretty much invariably leads to attempting to experiment with pushing my dosage for other drugs into new/uncharted ("maybe I can manage to make brorphine euphoric if I just keep vaping more and mo-" WHAMMY, OD*)

*spoiler alert, it didn't work

Yeah the benzo disinhibition is crazy. Like it just activates your simplest desires, which are usually just to get high, drink, and eat junk food. Idk if you're a fan of Always Sunny but I was reminded of this scene which I feel like pretty much exemplifies the type of conversation I have with my brain on benzos.

And yeah the thing about combos is that you feel like you can tweak your high to get it "just right" like "ooh this coke is nice but it's making me pretty jittery, luckily I can adjust that at will."

 

[Dextro .45]

Benzos & Opioids are very doable together…safely, knowing your own tolerance, go slow and adjust dosage to optimal level.

I do this daily sometimes… Methadone 80mg daily for years in morning, after work sometimes I take an additional 12.5mg Methadone + Valium 10mg + Gabapentin 300mg + Cannabis Indica 10mg oral around 5/6pm ish to enjoy until 11pm bedtime and feel GREAT

large doses of both are at risk of CNS depression while sleeping …..VERY dangerous for a rookie or someone pushing the envelope too far.

 

[nodgod]

Hi all,

I’ve struggled to find any answers this question by conventional means as all I get is scaremongering: How much do benzos and opiates interact? I know that they do and all the information is “Don’t do this”…but what about for low doses. Is the interaction of the type that one just combines the CNS depressing effects of both, or is there a real interaction where both together is more than twice of one on their own? Would taking like 60mg of codeine with 5mg of diazepam (Valium) be safe for someone with no tolerance? I would think so, assuming there isn’t a crazy interaction…its just hard to get quantitative estimates of the interaction as all websites just so “DON’T DO THIS’. Any suggestions for resources to find more info or personal experiences?

Cheers.

Currently (hospitalized AND informed them I’m in recovery, August making 3 YEARS) and they got me on 30mg oxy every 4 hours with 2mg klonopins morning and night. Beware the pharm industry they’re just legal dealers. I’m going to have to go back on subutex I can tell, and it’s wrong because I TOLD and SHOWED them my scripts for subs already

 

[nodgod]

Hi all,

I’ve struggled to find any answers this question by conventional means as all I get is scaremongering: How much do benzos and opiates interact? I know that they do and all the information is “Don’t do this”…but what about for low doses. Is the interaction of the type that one just combines the CNS depressing effects of both, or is there a real interaction where both together is more than twice of one on their own? Would taking like 60mg of codeine with 5mg of diazepam (Valium) be safe for someone with no tolerance? I would think so, assuming there isn’t a crazy interaction…its just hard to get quantitative estimates of the interaction as all websites just so “DON’T DO THIS’. Any suggestions for resources to find more info or personal experiences?

Cheers.

They both make eachother stronger. Benzos are opiate AGONISTS while opiates are benzos agonists. The opposite off antagonist which would mean they would have opposite effects or worse (think Narcan when you’ve been on fent or boy) so in my personal, 15 years of experience mixing both illegally and also certain points in my life ive mixed them legally. But I’ll tell you where that road leads as well, seeing as how my aunt is dying from her addiction to fent patches, oxy and dilaudid plus klonopin. Her entire stomach no longer works due to years of opioids. They block the signals in the brain as well as shut down the GI system, but slowly. Past 10 years she’s a miracle to be alive, as she is fed and takes her meds through a G tube (tube straight to her stomach) this has led to all sorts of other issues like barres something I can’t really recall every issues name, but gastroparesis, her stomachs essentially frozen. She can’t eat by mouth, and at this point she’s so physically addicted to it all, she confuses withdrawals with pain from her real (self induced or not) issues. This all started with her doctor shopping back in the 80mg oxy days and she just never stoppped. Shes in her mid 60s and literally on her death bed. Compare that to her sister’s, both similar age, but one works out and takes nothing illegal and the other takes low doses of anxiety meds and antidepressants…. My fathers family was all alcoholic coke heads from NYC. And it does pass through genetics. If you wish to SAFELY MIX opioids and benzos, speak to an addiction specialist and get subutex or suboxone generics if the Tex aren’t available, and have them put u on 1-2 mg kpins twice daily. Every addiction specialist you tell you’re on heroin and meth won’t hesitate to try to help. And taking them as prescribed, as in dissolving a whole tablet under your tongue after taking your morning dose of benzos. You’ll probably nod out at first which obviously you enjoy. But after a month you’ll level out and not be so tired and then you’ll realize you just went a MONTH clean (everyone takes a different route, and you need MAT like I did which is medication assisted treatment paired with counseling. I’m 31 bro. Prison 3 times. August 3rd is 3 years clean. I own 3 businesses outright meaning any and all income is mine from all 3 single entity LLCs. I’ll even help u with that it’s very very easy and all of our best bets in life because it protects and separates you and your finances from your companies. But don’t go mixing street shit. All the fent had xylazine now, an animal tranquilizer. To kill you. Cuz when a junkie dies the rest knows it was “good”. Get out and away asap. In the meantime focus on quitting meth and heroin before you get a poorly blended batch and overdose for good. I’ve OD’d atleast 10-15 times, 3-4 hospitalizations after a few of them due to the fact I didn’t know the answer to the questions of my name or the year, day, president etc. the detox I went through can’t turkey in jail. Before I was clean it was 2-4 grams of ice and 1-2 grams minimum of fentanyl. 60 days bro lol I pray u find the rooms

 

[simplefilter]

Yes, they can and do potentiate the effects of each other. One way is by using different mechanisms in your body to achieve the same result: suppressing your nervous system. Since there are two paths (I’m oversimplifying here - check the literature on the binding sites of different receptors), it’s more dangerous. You could double up your lethal hit via two mechanisms at once. Another way they work together is by occupying the same metabolic pathway and liver enzyme. Basically taking longer to leave your system, and benzos can be notoriously long lasting. This makes dosing really hard to figure out if you’ve been using for a few days. It’s also hard to stabilize someone in the field who’s using different things. Narcan is pretty available, the antidote to benzos is much less so.

Yes, pharmaceutical grade medications are unlikely to kill you in a hospital while you’re being monitored and that particular combination is well established in practice for your weight and established tolerance.

No, tiny doses of these things might not kill you unless you’re unaware of how much is already in your system or a tiny dose is all that it takes to kill you. Fentanyl. That’s a significantly scary “unless.”

Most people source from some guy, who in all likelihood these days doesn’t really know what is in what you’re taking. And it changes. My sister dosed herself just fine for years, until she didn’t. That’s usually how it goes.

 

[simplefilter]

Benzos & Opioids are very doable together…safely, knowing your own tolerance, go slow and adjust dosage to optimal level.

And I’m sorry, but these kinds of blanket statements are just totally uninformed - at best.

“Sure seems fine, even though I know nothing about your sourcing or usage or really anything specific about this situation, because I do something that sounds similar with tons of experience and I haven’t gotten unlucky.” This is what I hear.

 

[ChemicallyEnhanced]

Hi all,

I’ve struggled to find any answers this question by conventional means as all I get is scaremongering: How much do benzos and opiates interact? I know that they do and all the information is “Don’t do this”…but what about for low doses. Is the interaction of the type that one just combines the CNS depressing effects of both, or is there a real interaction where both together is more than twice of one on their own? Would taking like 60mg of codeine with 5mg of diazepam (Valium) be safe for someone with no tolerance? I would think so, assuming there isn’t a crazy interaction…its just hard to get quantitative estimates of the interaction as all websites just so “DON’T DO THIS’. Any suggestions for resources to find more info or personal experiences?

Cheers.

Personally, never made a difference. I think A LOT is fearmongering.
Like when I went on Methadone, all the medical people were like "If you have even ONE drink of alcohol while on Methadone, you WILL DIE"...then I relapsed on alcohol and drink a liter of vodka and 3 bottls of wine a day and was FINE. Ditto for taking Xanax on Methadone.

 

[lolis my thesis]

I take 20mgs methadone, 2mgs klonopin, 300mg pregabalin every day. I feel like its safe after 20 years. As the doctors force me off, I am more and more tempted to use street or internet sourcing of drugs rather than the white coats who at least calibrate my doses so I know what I am taking. For what it's worth; I feel like telling my doctor, no way can I abstain for a week off methadone just to safely take suboxone. Sure, then my OD potential will be less, but after 20 years, and lots of pain, I can't fathom going weeks in w/d only to fear precipitated w/d, to get off methadone which treats my pain well. I don't know if suboxone will be as efficient. I really don't know what to do rather than go to the methadone clinic for methadone.
My pain doc retired, but the methadone clinic won't keep me at 20 mg. They will give me more if I ask; although good luck with take homes given the benzos.
But no OD for 20 years, and the doc wanting me to switch is 37, and I am 57. Meaning I been on methadone and benzos since he first took a hit of pot.

 

[Dextro .45]

And I’m sorry, but these kinds of blanket statements are just totally uninformed - at best.

“Sure seems fine, even though I know nothing about your sourcing or usage or really anything specific about this situation, because I do something that sounds similar with tons of experience and I haven’t gotten unlucky.” This is what I hear.

Ummmm…..there are probably over 100,000+ heck probably 500k….a mill? in the US alone who are prescribed both Opioids & Benzodiazepines in long term therapy for chronic pain & anxiety/PTSD and trauma conditions

Being on Methadone 125mg daily for 20+ years and my tolerance is very high, and benzodiazepine in the range of Diazepam 30 daily is not an issue in an adult male 240lbs 6’ on fasted state ……tolerance building in long term use.

15-20mg Methadone of a naive Individual would require medical intervention/Narcon mu-antagonist, 40-50mg significantly lethal. My daily dose could kill an opioid naive adult male two times over easily.

Many family physicians prescribe both opioid & benzos….with professionally prescribing practices, monitored by weekly initial checkups, low dose escalation initially, if severe chronic condition after exploring 1st line treatments, low dose opioid analgesic initiated, several years + of tolerance…..low dose Diazepam or Lorazepam as an anxiolytic even in addition to Pregabalin (Lyrica) or Gabapentin ….Clonidine and or Trazadome for night

When a patient has been with their family physician for 30+ years, etc and knows your history with medical conditions legit the patient would safety be introduced to these therapeutic compounds and with time & tolerance dose escalation is inevitable

Dip shit stupid cocktails, DDI’s , adverse reactions, CNS depression, etc can and will happen with people pushing the limits. In low therapeutic doses under the observation and hopefully professional opinion of your medical prescriber/ doctor and it’s a very safe and effective regiment

10 years building tolerance, then 15+ years on hybrid Brompton cocktail Opioid, dopaminergic stimulant, benzodiazepine and Gabapentinoid….even ethanol & nicotine ….its a very safe and therapeutic combination for me, and each compound serves a purpose, not just added for shitsNgiggles

Be safe….and know you limits/tolerance…..don’t be afraid to call 911. I did twice, both false alarms kinda, but fuck it…those are my tax dollars and my physical safety is paramount.

Cheers

 

[lolis my thesis]

my young doc insisted I carry narcan; then having it at home allowed my to save a life other than my own. So as pissy as I am about his wanting to wean me off meds, I am forever in his debt as the narcan I carried saved a life, that of my son's who took a hot line of cocaine. my 8mgs weren't quite enough; I carry 12 as the paramedics just said that 12mgs was the norm these days to revive a fent overdose. Meant for a terrible few minutes administering CPR on my non breathing kid waiting on paramedics who just gave him 4 additional mgs.

So those that carry it or those who don't yet. Keep 12mgs narcan somewhere where you can use it quick

 

[Dextro .45]

I take 20mgs methadone, 2mgs klonopin, 300mg pregabalin every day. I feel like its safe after 20 years. As the doctors force me off, I am more and more tempted to use street or internet sourcing of drugs rather than the white coats who at least calibrate my doses so I know what I am taking. For what it's worth; I feel like telling my doctor, no way can I abstain for a week off methadone just to safely take suboxone. Sure, then my OD potential will be less, but after 20 years, and lots of pain, I can't fathom going weeks in w/d only to fear precipitated w/d, to get off methadone which treats my pain well. I don't know if suboxone will be as efficient. I really don't know what to do rather than go to the methadone clinic for methadone.
My pain doc retired, but the methadone clinic won't keep me at 20 mg. They will give me more if I ask; although good luck with take homes given the benzos.
But no OD for 20 years, and the doc wanting me to switch is 37, and I am 57. Meaning I been on methadone and benzos since he first took a hit of pot.

You should tell that doc to Fck off……nicely however, if you’re content and current therapy is working ….20+ years you’re obviously fully stable on Methadone ……OD potential is very low if you’re fully tolerant on stable dose for years and years

Methadone gives a pleasurable experience and is a very potent, long acting opioid analgesic / mu-agonist with excellent oral bioavailability…..125mg daily (168 tablets monthly) no b.s. weekly drinks, just a sealed factory bottle 100 tablets Metadol 25mg and jar of surplus tablets …..fuckn Ah

100 grams of pharmaceutical API compound powder of Pregabalin HCL shipped to my door and 10,000mg of Avizafone (Pro-Diazepam) 80mg shot for IM administration = Valium 40mg / 10-15min onset 0.75h C-Max compared to 1.5h oral Diazepam

Sometimes you have to go around those fucks …..once you find a legit professional vendor you should clean them out, I’d take 5K and buy their entire inventory if deemed beneficial

Too bad I didn’t do that with Diclazepam (2-Chloro Diazepam) I only bought 1,500mg when I should’ve bought 20-30 grams to last me 15-20 years …best benzodiazepine ever ……a super long acting anxiolytic synthasized by same chemist who made Valium & Klonopin

Diclazepam > Delorazepam >> Lorazepam (Ativan) 200+ h half life…..potential of drug accumulation with daily dosing due to looong acting metabolites, specifically Delorazepam 78h

Diclazepam oral dose 3mg …reaching C-Max of Delorazepam in 2 days ……lasting 5-7 days finally metabolizing into Lorazepam (Ativan) a solid anxiolytic

Avizafone (Pro-Diazepam) IM injection 80mg & Diclazepam (2-Chloro Diazepam) 3mg oral …Best Benzo’s for me

 

[Xyborg]

Hi all,

I’ve struggled to find any answers this question by conventional means as all I get is scaremongering: How much do benzos and opiates interact? I know that they do and all the information is “Don’t do this”…but what about for low doses. Is the interaction of the type that one just combines the CNS depressing effects of both, or is there a real interaction where both together is more than twice of one on their own? Would taking like 60mg of codeine with 5mg of diazepam (Valium) be safe for someone with no tolerance? I would think so, assuming there isn’t a crazy interaction…its just hard to get quantitative estimates of the interaction as all websites just so “DON’T DO THIS’. Any suggestions for resources to find more info or personal experiences?

Cheers.

What is your tolerance like to opiates? What about benzos? Daily or week use of either or both?

What you're reading on the Internet isn't only fearmongering; many many many people have died with this combo. It is very dangerous. And not to be advised in a harm reduction setting. However, you will do what you want to do. Answer the above questions so that we have somewhat of an idea of what type of user you are. This will aid on giving proper advice.

Again. Do. Not. Mix. These. Drugs. Before providing more information. Based on what you posted I'd guess you're intolerant to both opiates and benzos; as codeine is very weak as is valium. Being intolerant means this combo is not for you. That's a good thing. Keep it this way. You do not want to gain the tolerance to both in order the mix them safely.