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The purpose of this study was to examine both medical and nonmedical use of benzodiazepines among a community-based cohort of prescription opioid users.A total of 221 prescription opioid users from 2 rural Appalachian counties were recruited to participate in an interviewer-administered survey assessing sociodemographic characteristics, medical (source was valid prescription) and nonmedical (source other than prescription, such as dealer, friend, or family member) prescription drug use, illicit substance use, psychiatric disorders, and pain.Almost all of the participants (92.8%) reported lifetime benzodiazepine use and two thirds were current users. Only 29.3% of the current users had a legitimate prescription for a benzodiazepine. Current users were significantly more likely than nonusers to report nonmedical use of a variety of prescription opioids and other illicit drugs. The major source of benzodiazepines was a dealer.A high rate of nonmedical benzodiazepine use was observed in this sample of prescription opioid users. Physicians should, therefore, be aware of the potential for nonmedical use of benzodiazepines. Implications for treatment and future research are discussed.