What is the role of clonazepam (Benzodiazepine) in treating opioid use disorder?

From the Guidelines

Clonazepam has no established role in the treatment of opioid use disorder (OUD) and should not be used as a primary treatment for this condition. The provided evidence focuses on the management of REM sleep behavior disorder (RBD), where clonazepam is conditionally recommended as one of the treatment options 1. However, in the context of OUD, the primary treatments are methadone, buprenorphine, and naltrexone, which directly address opioid dependence by acting on opioid receptors. Clonazepam, as a benzodiazepine, may be used short-term and with caution to manage specific withdrawal symptoms, but its use is limited due to the risks of dependence, addiction, and increased overdose risk when combined with opioids.

Key considerations in treating OUD include:

• The use of evidence-based medications like methadone, buprenorphine, and naltrexone.
• The risks associated with benzodiazepines, including dependence and addiction.
• The importance of comprehensive treatment programs that include counseling and support services.
• The need for careful medical supervision and monitoring when using any medication, especially those with potential for abuse.

Given the potential for harm and the lack of direct benefit in treating OUD, clonazepam should not be considered a primary or preferred treatment option for opioid use disorder. Instead, treatment should focus on established, evidence-based therapies that directly address opioid dependence and are provided as part of a comprehensive care plan 1.

From the FDA Drug Label

Warnings Risks from Concomitant Use with Opioids: Concomitant use of benzodiazepines, including clonazepam, and opioids may result in profound sedation, respiratory depression, coma, and death. Abuse, Misuse, and Addiction: The use of benzodiazepines, including clonazepam, exposes users to the risks of abuse, misuse, and addiction, which can lead to overdose or death

The role of clonazepam in treating opioid use disorder is not directly supported by the FDA drug label. The label warns against the concomitant use of benzodiazepines (including clonazepam) and opioids due to the increased risk of respiratory depression, coma, and death. Additionally, clonazepam itself carries a risk of abuse, misuse, and addiction, which can lead to overdose or death 2. Therefore, clonazepam is not recommended for the treatment of opioid use disorder.

From the Research

Role of Clonazepam in Treating Opioid Use Disorder

• There is no direct evidence to suggest that clonazepam has a significant role in treating opioid use disorder 3, 4, 5, 6, 7.
• Clonazepam is a benzodiazepine that is commonly used to treat anxiety disorders and epileptic seizures, but its use in treating opioid use disorder is not well-established 3.
• The studies available focus on the use of clonazepam in treating panic disorder, depression, and other psychiatric disorders, rather than opioid use disorder 4, 5, 6, 7.
• Clonazepam may be used to treat symptoms associated with opioid withdrawal, such as anxiety and insomnia, but this is not a primary indication for its use 3.
• Further research is needed to determine the potential role of clonazepam in treating opioid use disorder, as well as its safety and efficacy in this context.

Potential Risks and Considerations

• Clonazepam can lead to physical dependence and tolerance, particularly with long-term use 3.
• The use of clonazepam in combination with other substances, including opioids, can increase the risk of adverse effects and overdose 3.
• Clonazepam should be used with caution in patients with a history of substance use disorder, and its use should be closely monitored by a healthcare professional 3, 4, 5, 6, 7.