Benzodiazepine drugs, or “benzos” as they are often called, are prescription psychoactive (mind-altering) drugs that have sedative-hypnotic, muscle relaxing, anxiolytic, and anti-convulsant effects. They may be prescribed to treat panic or anxiety disorders, insomnia, muscle tension, seizure disorders, as sedatives, used with anesthesia, or for help during alcohol withdrawal. With over 5 percent of the American adult population (those between the ages of 18 and 80) taking a benzodiazepine drug in 2008, according to the journal JAMA Psychiatry, this class of drugs is widely prescribed and also regularly abused.
As of 2011, the Drug Enforcement Administration (DEA) reports that over 20 million people in the United States had abused a benzodiazepine drug. Benzos can create a mellowing “high” when abused as they serve to reduce stress and anxiety. These drugs work by increasing levels of gamma-aminobutyric acid (GABA) in the brain, which in turns slows down some of the nerve firings related to the “fight-or-flight” reaction. This also suppresses functions of the central nervous system, like blood pressure, respiration, and heart rate, and lowers body temperature. Different types of benzos have slightly different mechanisms, durations of action, and effects, depending on the drug.
Benzodiazepines are generally broken down into the following categories (some may fit into various categories), depending on what they are usually prescribed to treat:
- Alprazolam (Xanax)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Chlordiazepoxide (Librium)
- Oxazepam (Serax)
- Clorazepate (Tranxene)
- Clonazepam (Klonopin)
- Flurazepam (Dalmane)
- Estazolam (Prosom)
- Triazolam (Halcion)
- Temazepam (Restoril)
Panic disorder medications:
Adjunct medications during anesthesia:
- Midazolam (Versed)
Alcohol withdrawal and detox medications:
Muscle relaxant medications:
Benzos may also be separated and categorized based on their duration of action or how long the drug stays active in the bloodstream. Midazolam and triazolam are classified as short-acting benzodiazepines while alprazolam, lorazepam, temazepam, oxazepam, and clonazepam are more intermediate-acting. Flurazepam, diazepam, and chlordiazepoxide are classified as having a long duration of action. The DEA reports that alprazolam, diazepam, clonazepam, temazepam, and lorazepam are the most prescribed and most frequently abused benzodiazepine drugs, which are classified as Schedule IV controlled substances. Alprazolam is among the top three licit prescription drugs being diverted into the illicit market, the DEA further indicates.
Benzodiazepine Abuse and Its Risks
Benzos are marketed in tablet, capsule, liquid, and injectable formulations, and they may be abused by swallowing, chewing, or crushing the tablets or capsules and then snorting, smoking, or injecting the resulting powder. Individuals may “shop” different doctors to obtain more than one prescription for a benzodiazepine, forge prescriptions, steal them from pharmacies or nursing homes, exaggerate or make up symptoms in order to get them, or obtain the drugs from a family member or friend.
Anytime a benzo is used without a legitimate medical reason and prescription, it is drug abuse. Abusing a benzo can be dangerous and cause many side effects, both physically and psychologically.
One of the more serious short-term side effects of benzo abuse is the potential for a life-threatening overdose when the drug overwhelms the body and reaches toxic levels in the bloodstream. A benzodiazepine overdose can slow breathing, pulse, and heart rate. It can lower body temperature, cause mental confusion and sedation, and possibly cause a person to lose consciousness, slip into a coma, or even die from cardiovascular or respiratory complications. Drug overdose is one the leading causes of accidental death in the United States, surpassing even motor vehicle crashes in 2014, the Centers for Disease Control and Prevention (CDC) reports.
The National Institute on Drug Abuse (NIDA) publishes that fatal benzodiazepine overdoses have increased fivefold from 2001 to 2014, up to around 8,000 deaths in 2014. Mixing a benzo with alcohol, opioids, or other central nervous system depressant drugs is especially dangerous and heightens the odds for suffering from an overdose.
Over 350,000 people needed treatment in an emergency department (ED) for a negative reaction to misusing a benzodiazepine medication in 2011, the Drug Abuse Warning Network (DAWN) reports. Potential side effects of benzodiazepine use and abuse beyond overdose include:
- Slurred speech
- Blurred vision
- Impaired motor skills and coordination
- Muscle weakness
- Nausea and gastrointestinal upset
- Appetite fluctuations
- Changes in sex drive
- Chest pain
- Irregular heart rate and blood pressure
- Mental confusion and trouble concentrating or thinking straight
- Short-term memory lapses
- Difficulties breathing
- Decreased inhibitions, leading to potentially dangerous behaviors
- Mood swings or shifts in personality
- Possible psychiatric symptoms, like hallucinations, depersonalization, or derealization
Benzodiazepine use may double the risk for individuals to develop dementia down the line as well, Psychology Today warns. Benzos are meant to be used only temporarily for psychiatric symptoms. Long-term use or abuse can cause drug tolerance, dependence, a withdrawal syndrome, and even potentially addiction.
Dependence and Tolerance
On one of the more common and popular benzodiazepine medications, Xanax (alprazolam), the US Food and Drug Administration (FDA) warns that prolonged use (for longer than three months) of dosages higher than 4 mg per day can lead to drug dependence even when used for medically necessary reasons and with a prescription. For this reason, benzos are typically considered short-term solutions for anxiety, insomnia, and panic disorders.
As benzodiazepine drugs change some of the levels of naturally occurring brain chemicals, thus impacting some of the pathways leading to reward processing, impulse control, memory, learning, and mood regulation, the brain can get used to certain amounts of the drug in the system.
This can create tolerance, and individuals may feel the need to keep increasing the dosage in order to get the same results. Abusing benzos regularly and continual dosage increases can raise the risk for developing a dependency on them.
Benzodiazepine dependence is recognizable by the withdrawal symptomsthat occur when the drug stops being active in the bloodstream. Since benzos have different durations of action, the onset of withdrawal may vary depending on the drug abused. On average, benzo withdrawal typically starts within the first few days of stopping the drug and can last for a week to 10 days (some of the psychiatric symptoms may continue for longer).
Rebound symptoms are common during benzo withdrawal, as the brain has become accustomed to the central nervous system functions being suppressed. When the drug is removed, side effects that are virtually opposite to the drug’s effects may occur. Anxiety, insomnia, depression, tremors, muscle tension, nausea, difficulties concentrating, sweating, irregular heart rate and blood pressure, irritability, headache, muscle pain, drug cravings, and panic attacks are common benzodiazepine withdrawal symptoms.
Benzo withdrawal syndrome can be dangerous and even life-threatening, as seizures and irregularities in cardiovascular functions may occur when a person is significantly dependent on the drug. For this reason, it is not ever recommended to stop taking a benzo suddenly, or “cold turkey,” without professional help.
Medical detox can aid in the safe removal of a benzodiazepine drug from the body while helping to stabilize the brain and manage withdrawal symptoms, often with the help of medications. Benzos may be slowly reduced over time to keep withdrawal symptoms from being as intense, and short-acting benzodiazepines may be replaced with longer ones during a tapering schedule in detox. Additional medications and supportive measures are also beneficial during benzodiazepine detox, helping to manage withdrawal side effects and rebalance the body and brain.
Drug tolerance and dependence are physical manifestations of long-term benzo use or abuse that can also lead to emotional and behavioral changes, including an inability to stop taking these drugs and a loss of control over their use. The American Society of Addiction Medicine (ASAM) defines addiction as a brain disease leading to a breakdown in impulse control and continued drug use despite full awareness of multiple negative consequences. Individuals may attempt to stop taking drugs multiple times with no success and may end up taking more of them at a time and for a longer period of time than they meant to.
Mood swings, increased secrecy, hostility, shame, self-harming behaviors, and difficulties maintaining healthy interpersonal relationships are common signs and side effects of addiction. Individuals may be unable to keep up grades or work production and not consistently fulfill other obligations to family and friends. Sleep schedules and eating habits can become erratic, and emotions may be volatile and unpredictable. Physical appearance often declines, and individuals may engage in dangerous or even illegal activities as a result of drug-seeking or drug-using behaviors. Financial strain and a lack of interest in things, people, and activities that were important before may be typical ramifications of drug addiction.
Benzodiazepine drugs are considered addictive substances. Specialized treatment and support are needed for those addicted to benzodiazepines to sustain recovery. Addiction treatment can provide the tools and necessary time for the brain to heal. With the right help, full recovery is possible.