benzodiazepines guide


What are Benzodiazepines?

Benzodiazepines are a class of psychoactive drugs commonly used as anxiolytics, sedatives, and hypnotics. They work by binding to the GABA receptors in brain cells which reduces stress and anxiety levels, relaxes muscles (easing spasms), induces sleep, lowers convulsions caused by epilepsy, and prevents seizures. Benzo drugs are also used as a general anesthetic.   

History of Benzo Use

Benzodiazepines have been around for over 50 years. Dr. Leo Sternbach first synthesized them in 1955 as an alternative to barbiturates due to their less severe side effects. The first benzo drug produced was chlordiazepoxide (Librium).1 They have been widely prescribed for decades because they can be effective at treating many conditions that cause people to stress or have difficulty sleeping.

Although they were originally developed as a treatment for anxiety and insomnia, they have since turned into the substance of abuse that is most often abused in America.      

Drug Class and Schedule

Benzos are a class of drugs primarily used for treating anxiety, and they work by reducing stress levels in your brain cells to help you feel more relaxed. They also prevent seizures that may happen as well as make it easier for you to sleep.

Benzodiazepines are controlled in Schedule IV of the Controlled Substances Act.2   

Types of Benzodiazepines

Benzodiazepines are known by their generic name or brand name. Some of the most common benzodiazepines include:

  • Diazepam (Valium): Valium is a medication that belongs in the benzodiazepines family. It is used to treat many conditions, including anxiety, muscle spasms, and insomnia. Valium can also be prescribed for patients suffering from seizures or convulsions due to epilepsy and for those going through alcohol withdrawal.
  • Lorazepam (Ativan): Lorazepam, sold under the brand name Ativan, is a benzodiazepine medication. It is used to treat anxiety disorders, trouble sleeping, and seizures.
  • Alprazolam (Xanax): Alprazolam, sold under the brand name Xanax, belongs to a class of medications called benzodiazepines. It is used to treat panic and anxiety disorders.
  • Clonazepam (Klonopin): Clonazepam, sold under the brand Klonopin, is a medication used to prevent and treat seizures and panic disorder.     

Benzodiazepines Guide: What do Benzodiazepines Treat?

Anxiety

Benzos are commonly used for the treatment of anxiety. They affect the brain’s GABA receptors, which slows down the activity in the central nervous system (CNS). The patient may experience feelings of relaxation.

Benzodiazepines were once the most commonly prescribed treatment for anxiety. Today, there are newer and more effective treatments available that carry a smaller risk than benzodiazepines.

Benzos most commonly used to treat anxiety disorders are clonazepam, alprazolam, and lorazepam.        

Seizures

Benzodiazepines are an important medicine in the treatment of epilepsy. They are primarily prescribed for status epilepticus and seizures associated with post-anoxic insult due to their rapid onset of action, high efficacy rates, and minimal toxicity.3

Benzodiazepines used for the treatment of seizures include clonazepam (Klonopin), clorazepate, lorazepam, clobazam, and diazepam (Valium).    

Insomnia

Benzodiazepines have been used for the treatment of insomnia since the 1970s. They can reduce anxiety and promote restful sleep by binding to the gamma-aminobutyric acid-A (GABA-A) receptors in the brain.

Benzos used for the treatment of insomnia include lorazepam, nitrazepam, oxazepam, temazepam, triazolam, and flurazepam.    

Anesthesia

Alongside their ability to slow down activity in the central nervous system, benzodiazepines have a dose-dependent ventilatory depressant effect. As such, they are widely used in clinical anesthesia. The four benzos used in clinical anesthesia include the agonists midazolam, diazepam and lorazepam, and the antagonist flumazenil.4    

Muscle Relaxation

Due to their ability to decrease activity in the central nervous system, benzodiazepines are often prescribed for the treatment of muscle spasms. Benzodiazepines are used along with rest and physical therapy for short-term relief. Diazepam is the only benzodiazepine that is FDA-approved for the treatment of spasticity and muscle spasms.   

Alcohol Withdrawal

Benzodiazepines are a safe, effective, and preferred treatment for alcohol withdrawal. Various benzodiazepines have a rapid onset of action, a long duration of action, low potential for abuse, and are generally safe. These properties make them the ideal medication for the treatment of alcohol withdrawal.5

Benzodiazepines Guide: Are Benzodiazepines Addictive?

When used as recommended by a medical professional and only for a few weeks, benzodiazepines have a low risk of addiction. However, the risk for addiction increases if the substance is taken regularly for more than a few weeks, especially in higher doses. People with a history of substance abuse are also more at risk of developing an addiction to benzodiazepines.

In 2008, around 75 million prescriptions were written for benzos. It is estimated that the prevalence of benzo use in the general population is 4% to 5%. Most individuals take benzodiazepines as recommended, while 2% escalate to taking high doses and even meeting the criteria for abuse or dependence on this substance.6

In addition, roughly 2.3% to 18% of Americans have misused sedatives or tranquilizers in their lifetime. Around 10% of those individuals met the criteria for abuse or dependence. In 2010, there were approximately 186,000 new abusers of benzos.6     

Benzodiazepines Guide: Benzos Side Effects

Short-Term

Some of the most common short-term side effects of benzodiazepines include:

  • Drowsiness
  • Coordination problems
  • Appetite loss
  • Dry mouth
  • Nausea
  • Relaxation
  • Impaired memory
  • Slowed motor function
  • Slowed breathing
  • Problems with vision

Long-Term

The most common long-term side effects of benzodiazepines include:

  • Increased risk of addiction
  • Impaired judgment
  • Confusion
  • Cognitive decline
  • Memory problems
  • Muscle weakness
  • Slurred speech
  • Increased risk of accidents

Benzodiazepines Guide: The Dangers of Benzodiazepine Abuse

Withdrawal Timeline

There are three possible phases for benzodiazepines withdrawal, including:

  • Early withdrawal:This phase starts shortly after a patient stops taking benzodiazepines. The patient may experience some of the symptoms of the condition the drug was treating. For example, if the patient was taking benzodiazepines to help with their anxiety, their anxiety symptoms may return or worsen.
  • Acute withdrawal:. This phase begins after the early withdrawal symptoms. The symptoms of acute withdrawal usually last for 5 to 28 days. Most of the withdrawal symptoms happen during this phase.
  • Protracted withdrawal: Although most of the withdrawal symptoms subside after the second phase, some symptoms may linger. Lingering benzo side effects are possible if the patient was taking benzodiazepines in higher doses and for a longer period. Some patients may experience withdrawal symptoms 12 months or more after quitting.     

Benzo Withdrawal Symptoms

Although not everyone experiences the same benzodiazepine withdrawal symptoms, there are some of the most common:

  • Muscle spasms
  • Sweating
  • Weight loss
  • Anxiety
  • Trouble concentrating
  • Abnormal bodily sensations (goosebumps)
  • Hyperventilation
  • Nausea
  • Insomnia
  • Panic attacks
  • Vomiting
  • Depression
  • Irritability
  • Headache
  • Hallucinations and delusions
  • Hypersensitivity to stimuli like light and touch
  • Grand mal seizures    

Benzo Overdose

In 2019, 16% of overdose deaths involving opioids also involved benzodiazepines.7 Benzodiazepine overdose can be fatal if the patient uses the drug with alcohol or opioids or takes too much of the drug.

Some of the most common effects of benzo overdose include:

  • Confusion
  • Extreme drowsiness
  • Decreased reflexes
  • Respiratory depression
  • Coma
  • Death     

Benzodiazepines Guide: Misconceptions about Benzodiazepines

Some misconceptions surround benzodiazepinestheir use, and their risk for addictionA few of the most common misconceptions about benzos are listed below:    

  • Misconception #1: Benzodiazepines can be prescribed for many medical conditions.
  • Fact: Many physicians are hesitant to prescribe benzodiazepines due to their risk for dependence.
  • Misconception #2: Benzodiazepines are not addictive.
  • Fact: Benzodiazepines can be addictive and dependence forming, with withdrawal symptoms such as insomnia, anxiety, muscle spasms, and depression.
  • Misconception #3: Benzodiazepines do not lead to a fatal overdose.
  • Fact: Fatal overdose with benzodiazepines is rare, but an overdose can still occur if someone combines benzos with other risky substances such as alcohol or opioids.
  • Misconception #4: Quitting cold turkey is safe.
  • Fact: Quitting benzodiazepines all at once can be deadly. Some benzodiazepine side effects from quitting cold turkey may include paranoia, mania, psychosis, seizures, and convulsions.

Treatments for Benzo Addiction

Tapering

Tapering involves gradual decreases in dosage over a couple of weeks. The gradual decrease of the substance of abuse can help avoid the negative withdrawal symptoms. Whether the taper will happen more quickly or slowly depends on the patient’s needs.

A patient battling with a more severe benzodiazepine dependence may be put on a tapering schedule that involves smaller reductions over an extended period. It is recommended that the initial reduction should be 25-30% for high dosage users, followed by further reductions of 10-25% every 1-2 weeks.8

Some patients may benefit from switching to a long-lasting benzodiazepine, especially if they have been abusing the drug for a longer time.    

Medically Supervised Detox

The first step in benzo addiction treatment is a medically supervised detox. Detoxification involves eliminating the drug from the patient’s system. During detoxification, the patient receives 24/7 medical care from addiction specialists, nurses, and doctors, helping them safely detox from substances in the most comfortable way possible.     

Therapies

Detoxification deals with the physical aspects of addiction. However, it does not address any mental health disorders. A patient is recommended to participate in drug addiction therapy to deal with the underlying causes of drug addiction. 

Mental health treatment can consist of different therapies, including counseling, behavioral therapy, art, and exercise. These various therapies aim to help the patient live a healthier life and build the skills necessary to quit misusing substances. The patient’s negative thoughts and behaviors need to be replaced with positive habits that will help prevent relapse even after treatment.     

  1. https://pubmed.ncbi.nlm.nih.gov/24007886/
  2. https://www.dea.gov/sites/default/files/2020-06/Benzodiazepenes-2020_1.pdf
  3. https://pubmed.ncbi.nlm.nih.gov/18384456/
  4. https://link.springer.com/chapter/10.1007/978-3-540-74806-9_16
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606320/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007645/
  7. https://www.drugabuse.gov/drug-topics/opioids/benzodiazepines-opioids
  8. https://www.va.gov/painmanagement/docs/OSI_6_Toolkit_Taper_Benzodiazepines_Clinicians.pdf