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A long-acting and relatively rarely prescribed benzodiazepine drug within the United States, medazepam is marketed for the treatment of anxiety and panic disorders as an anxiolytic medication. Benzodiazepines are a class of drugs prescribed to treat anxiety, panic, and seizure disorders, as well as for insomnia, muscle tension, as an adjunct anesthesia medication, and for use during alcohol withdrawal treatments.
Intended for short-term use due to their propensity to cause drug tolerance and dependence with chronic and prolonged use, benzodiazepines act on levels of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter that is active in reducing the stress reaction and slowing down some of the autonomic functions of the central nervous system. Heart rate, blood pressure, body temperature, and respiration rates are all suppressed by medazepam and other benzodiazepine medications. Levels of dopamine – one of the brain’s chemical messengers that signals when to feel pleasure – are also elevated by benzodiazepine drugs.
When used outside of a licit prescription or medicinal need, these drugs can create a euphoric effect similar to that of alcohol intoxication. According to the Drug Enforcement Administration (DEA), more than 20 million Americans (as of the year 2011) had abused a benzodiazepine drug at least once in their lives. Causing a decrease in inhibitions, slurred speech, impaired coordination, reduced muscle control, impaired decision-making abilities, reduced learning and memory functions, vertigo, drowsiness, increased relaxation, and elevated moods, medazepam intoxication may lead to increased risk-taking behaviors, poor impulse control, and regrettable actions.
The 2014 National Survey on Drug Use and Health (NSDUH) indicates that individuals between the ages of 18 and 25 abuse sedatives and tranquilizers at the highest percentage rate, although in number, those aged 26 and older misuse them most. Since these are prescription medications, any misuse of these drugs is considered drug abuse. Medazepam may be abused by ingesting, smoking, snorting, or injecting the drug. Regular use of medazepam can cause dependence and addiction.
Even when the drug is used with a licit prescription for a medical purpose, dependence on medazepam can set in with even relatively short-term use, the International Programme on Chemical Safety (IPCS) warns. Drug dependence is when physical changes to the chemical makeup of the brain are altered from regular drug use or abuse. In the case of a benzodiazepine like medazepam, regions of the brain that are affected include parts involved in the regulation of emotions, formation of short-term memories, and impulse control. A sort of shortcut to reward is created with chronic recreational drug use, and normal transmission, absorption, and production of the brain’s chemical messengers are disrupted. Levels of dopamine and GABA then plummet when medazepam wears off, causing significant physical and psychological withdrawal side effects.
All of the symptoms medazepam worked to suppress may come flooding back as the brain experiences a rebound effect with the drug’s removal. Anxiety, depression, irritability, restlessness, insomnia, mental “cloudiness,” difficulties with short-term memory, panic attacks, and drug cravings are common psychological withdrawal side effects of benzodiazepine drugs. Physical symptoms include tremors or even seizures, hypertension, a racing heart rate, sweats, muscle tension, stomach upset, nausea, headache, loss of appetite, and muscle pain. These side effects can be significant; therefore, medazepam should not be stopped “cold turkey.”
Drug dependence and the presence of withdrawal symptoms are potential signs of addiction. Addiction is more than merely physical drug dependence, however. It also includes behavioral changes and a loss of control over drug use. Someone who suffers from medazepam addiction may do anything in their power to try and obtain the drug, from seeking out multiple prescriptions from different doctors (“doctor shopping”), to inventing psychiatric symptoms to obtain the drug, to forging prescriptions or stealing the medication from a doctor or pharmacy, to buying the drug online or from a drug dealer.
The 2013 NSDUH reports that prescription drugs are most commonly obtained for abuse for free from a friend or relative, however. Compulsive and out-of-control drug-seeking behaviors are warning signs of addiction. Continued use of the drug despite the known consequences, using it in risky or hazardous situations, and an inability to stop using medazepam are further indicators of addiction. Addiction is a disease affecting the brain’s circuitry and chemical balance with negative behavioral, emotional, physical, and social consequences.
The half-life of medazepam is estimated to be between 36 and 200 hours, making it an extremely long-acting benzodiazepine drug. The half-life of a drug is the time it takes for it to be broken down in the body until it is half as effective. By doubling the half-life, one can get an indication of when the drug will be completely out of the system and no longer active.
Depending on the severity of a person’s physical level of dependence on medazepam, withdrawal may range in intensity and duration. The more medazepam a person used, and for a longer time, the more dependent the brain likely is on it and the more difficult withdrawal may be. Environmental, genetic, and biological factors can play a role in drug dependence and therefore withdrawal, also making detox a highly individual experience. Detox generally adheres to the following timeline for medazepam:
Medazepam withdrawal can be smoothed out and the symptoms controlled with a slow and controlled tapering schedule set up in a medical detox program. The dosage can then be slowly lowered over a period of time until it is completely removed from the body. Medical detox provides medical and mental health supervision, care, monitoring, and support 24 hours a day for a period of 5-10 days (on average). Vital signs can be closely monitored to ensure no adverse reactions occur, and emotional support and encouragement are provided around the clock.
Medications can be useful in targeting specific symptoms of medazepam withdrawal during medical detox. With a blend of pharmacological and supportive care, medical detox can help a person to become physically stable and ready to enter into a substance abuse treatment program.
A comprehensive assessment and thorough evaluation is often one of the first aspects of an addiction treatment program, as it can determine what type of treatment model is ideal.
Both residential and outpatient treatment models are options in addiction treatment. With an outpatient treatment program, individuals should have a high level of support at home and are likely less significantly dependent on medazepam. Residential, or inpatient, addiction treatment models provide the highest level of care and support.
It is essential that individuals remain in a program for long enough to establish healthy habits and allow their brain time to heal. The National Institute on Drug Abuse (NIDA) reports that treatment programs should be at least three months in duration and sometimes longer. The specific type of treatment program is highly individual and dependent on the specific needs of the individual.
The journal Drug and Alcohol Dependence publishes that in the 10 years between 1998 and 2008, treatment admissions for benzodiazepine abuse almost tripled. In addition, benzos are commonly abused with other psychoactive substances. Polydrug abuse, or using multiple drugs at once, can complicate treatment measures and requires specialized care. Medications may need to be altered in the presence of polydrug abuse, for example. For this reason, a complete drug screening is often an important component of a substance abuse treatment admission program.
Co-occurring disorders are also commonly present in the case of benzodiazepine addiction, as the Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that 7.9 million Americans who were 18 or older in 2014 battled co-occurring disorders. When this is the case, integrated treatment models addressing all aspects of both disorders are needed.
Behavioral therapies, counseling, and life skills training sessions can help clients to learn new coping mechanisms, methods for reducing stress in a healthy and productive manner, and improved interpersonal relationship and communication skills. By improving self-esteem and one’s sense of self-worth, negative and self-destructive behaviors like medazepam abuse may be reduced. Support groups are helpful for providing a peer network that can offer encouragement, empathy, support, and established methods for minimizing relapse, by providing a place to commiserate with other individuals who have quite literally “been there, done that.”
Relapse prevention techniques and tools are also part of aftercare and transitional programs. Nutrition planning, fitness programs, creative therapy, mindfulness meditation, and other natural and holistic methods that address “whole body” healing can help individuals to create a healthy lifestyle that will carry on long into recovery.