Benzodiazepines

Benzodiazepines such as Xanax and Valium can help relieve anxiety, but have potential for abuse and severe withdrawal symptoms.

Benzodiazepines

Benzodiazepines such as Xanax and Valium can help relieve anxiety, but have potential for abuse and severe withdrawal symptoms.

Benzodiazepines are medications doctors prescribe to relieve anxiety and, in some people, prevent seizures. While they are legal medications, benzodiazepines have the potential for abuse, and many people abuse them by mixing them with other substances, such as alcohol. Let’s discuss benzodiazepines history as a medication and how they can become a substance of abuse and addiction in some individuals.

Where Do Benzodiazepines Originate?

Chemist Leo Sternbach identified the first benzodiazepine in 1955, a drug known as chlordiazepoxide and sold under the commercial name Librium.1 Pharmaceutical manufacturer Hoffman-La Roche (who Sternbach worked for) first marketed the drug in 1960. The drug emerged as a competitor for the anxiety-relieving drugs of the time, which were known as barbiturates. Benzodiazepines seemed a safer alternative to barbiturates because they were less likely to cause respiratory depression (slow breathing) that could lead to overdose and death.

In 1963, Hoffman-La Roche released another benzodiazepine medication that had been modified from the original Librium formula. They called the drug diazepam or Valium. This medication became a very popular one, and represented one of the most-prescribed medications of the 1970s. In 1973, an estimated 87 million people were prescribed Valium to treat anxiety and other related medical conditions. 2

Since the discovery of Librium and Valium, there are other benzodiazepines available on the market. These include alprazolam (Xanax), clonazepam (Klonopin), and midazolam (Versed). While all of these medications relieve anxiety, they have differences in terms of duration of action.

The increase in popularity of Valium also led to researchers and the medical community casting a closer eye on the medication, including how it worked and how it affected others. Medical professionals started to observe greater instances of addiction and abuse of benzodiazepines. They also started to notice how the medications could have greater sensitivity in the elderly. All of these findings started to spark greater awareness about the use of benzodiazepines and their addictive potential.

Doctors continue to widely prescribe benzodiazepines. According to an article published in the American Academy of Family Physicians journal, Xanax was the number-one most prescribed psychotropic medication in the United States in 2009.3 Other benzodiazepines were the 2, 6, and 7 most-prescribed psychotropic medications.

What Do Benzodiazepines Do to the Body?

Interestingly enough, pharmaceutical manufacturers didn’t pinpoint the exact mechanism that benzodiazepines worked in the body until about 15 years after their initial approval. 1 Scientists started to link benzodiazepines mechanism of action as affecting GABA receptors in the brain. GABA is a neurotransmitter that has an inhibitory or “slowed-down” effect on the brain.2

This results in a sedative and anxiety-relieving effect. However, the receptors for GABA are very low in the brainstem – as a result, benzodiazepines are less likely to cause respiratory depression than when compared to opioid medications like morphine and hydrocodone.

While benzodiazepines can have a positive effect on the body in terms of anxiety relief, they are meant for short-term use – usually about two to four weeks. However, many people take them chronically.

Benzodiazepines do result in a number of side effects. Examples of these side effects include:

It’s important to note that not every person who takes benzodiazepines will become addicted to them or abuse them. This is the same concept as not every person who drinks alcohol will abuse it. However, it is important to be aware of how benzodiazepines work, their side effects, and potential for abuse and harmful effects if mixed with other medications. 2

  • affected judgment
  • cognitive dysfunction
  • delirium
  • depressed mood
  • impaired motor skills
  • sedation
  • short-term memory loss
  • worsening of some respiratory conditions, including COPD and sleep apnea

 

It’s important to note that not every person who takes benzodiazepines will become addicted to them or abuse them. This is the same concept as not every person who drinks alcohol will abuse it. However, it is important to be aware of how benzodiazepines work, their side effects, and potential for abuse and harmful effects if mixed with other medications. 2

What Are the Long-Term Effects of Benzodiazepines on the Body?

Nearly 60 years after benzodiazepines first hit the medical market, scientists are understanding more and more about the long-term effects of taking benzodiazepines.3 Some of these effects include:

  • Uncomfortable and prolonged withdrawal symptoms that can last up to several months after a person stops taking benzodiazepines.
  • Cognitive impairment – taking benzodiazepines long-term increases the risk for long-term cognitive impairment effects, including memory loss, extended reaction times, and greater episodes of drowsiness.
  • Greater risks for motor vehicle accidents. According to an article in the American Academy of Family Physicians journal, driving while using benzodiazepines is the equivalent of a near-illegal blood alcohol level of between 0.050 and 0.079 percent.

Doctors also often prescribe benzodiazepines to treat insomnia. However, benzodiazepines are intended for short-term use. Taking benzodiazepines longer than four weeks can lead to rebound insomnia in some people. 3 As a result, some consider alternative medications, such as trazodone or doxepin to help a person struggling with long-term insomnia.

According to an article in the American Academy of Family Physicians journal, in the United States, an estimated 4 million daily benzodiazepine users meet the criteria for substance dependence. 3 According to the article, using benzodiazepines for as little as one month of daily use is enough to cause withdrawal symptoms.

Doctors also often prescribe benzodiazepines to treat insomnia. However, benzodiazepines are intended for short-term use. Taking benzodiazepines longer than four weeks can lead to rebound insomnia in some people. 3 As a result, some consider alternative medications, such as trazodone or doxepin to help a person struggling with long-term insomnia.

According to an article in the American Academy of Family Physicians journal, in the United States, an estimated 4 million daily benzodiazepine users meet the criteria for substance dependence. 3 According to the article, using benzodiazepines for as little as one month of daily use is enough to cause withdrawal symptoms.

Common Misconceptions About Benzodiazepines

A common misconception about benzodiazepines is that because they are legal medications, they can’t be abused or harmful to a person. However, this is not true. People may abuse these medications as a means to achieve further sedation or euphoria when using opioids (pain-relieving medications) or alcohol. They also may use them to “come down” from using methamphetamines because they have a relaxing, sedative effect on the body. 2

While it’s true that when taken alone, benzodiazepines are unlikely to cause overdose, when a person takes them with other sedating medications, a person can overdose. Examples of these medications include opioids and alcohol.

Another misconception about benzodiazepines is that they are an excellent choice for prescription in the elderly. The elderly commonly experience medical conditions that may initially seem highly treatable with benzodiazepines. These include agitation, delirium, or insomnia.2 However, doctors have connected taking benzodiazepines with increased risks for hip fractures, falls, motor vehicle accidents, and cognitive impairment. Therefore, they are not widely recommended for use in patients older than age 65 or in anyone who already struggles with cognitive impairment.

What Is Detox from Benzodiazepines Like?

Detoxing from benzodiazepines can be dangerous without medical monitoring because if a person abuses benzodiazepines and has taken them for some time, immediately withdrawing from benzodiazepines could result in a seizure. 2 In addition to this risk, other potential symptoms associated with benzodiazepine detox include:

  • anxiety
  • delirium
  • psychosis
  • tremors

These symptoms are very similar to detoxing from alcohol.

Because detoxing from benzodiazepines does present life-threatening health risks, particularly seizure, most doctors won’t recommend suddenly stopping use. Instead, a doctor will usually recommend a tapering plan. This involves slowly reducing the amount of benzodiazepines taken on a regular basis. A variety of tapering program options exist. These include tapering a person’s average dose of benzodiazepines by about 10 percent every one to two weeks until benzodiazepines use stops entirely. It’s also helpful to consider alternative and supportive therapies, such as cognitive-behavioral therapy to help with anxiety throughout tapering off the dosages.

Additional options involve tapering a person’s medications with an adjunct medication. Examples include taking an anti-convulsant, such as valproic acid or carbamazepine for several weeks until benzodiazepines use has fully stopped and there is reduced risk of seizure. A doctor should discuss potential options with a person to determine what may work best for an individual.

Because detoxing from benzodiazepines does present life-threatening health risks, particularly seizure, most doctors won’t recommend suddenly stopping use. Instead, a doctor will usually recommend a tapering plan. This involves slowly reducing the amount of benzodiazepines taken on a regular basis. A variety of tapering program options exist. These include tapering a person’s average dose of benzodiazepines by about 10 percent every one to two weeks until benzodiazepines use stops entirely. It’s also helpful to consider alternative and supportive therapies, such as cognitive-behavioral therapy to help with anxiety throughout tapering off the dosages.

Additional options involve tapering a person’s medications with an adjunct medication. Examples include taking an anti-convulsant, such as valproic acid or carbamazepine for several weeks until benzodiazepines use has fully stopped and there is reduced risk of seizure. A doctor should discuss potential options with a person to determine what may work best for an individual.

What Are the Common Struggles in Getting Sober from Benzodiazepines?

Even if a person has never strayed from their initial long-term dose of benzodiazepines as prescribed to them, they can experience challenges when stopping the medication. This can include rebound anxiety and panic symptoms as well as feelings of depression. These can be understandably difficult to overcome without the support of rehabilitation professionals as well as friends and family.

Finding Help to Overcoming Benzodiazepine Addiction

According to the National Institute on Drug Abuse, an estimated 30 percent of overdoses in the United States involve benzodiazepines.4 If a person struggles with benzodiazepine abuse or uses benzodiazepines along with opioids or alcohol, it’s vital to seek help to prevent overdose. If you or someone you know struggles with benzodiazepine use, you can seek help by calling the National Drug Helpline at 1-888-633-3239. This is a 24-hour helpline that can provide the initial support needed to learn how to get safe help and support for quitting benzodiazepines for good.

In addition, Silvermist’s rehabilitation team are available around the clock to provide confidential care and help to those who are ready to seek help.

Resources

  1. https://medlineplus.gov/ency/article/000951.htm
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424120/
  3. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf
  4. https://www.drugabuse.gov/publications/drugfacts/prescription-cns-depressants
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1268024/?page=4