- Addiction & recovery
The Use and Misuse of Benzodiazepines
March 16, 2021
Benzodiazepines (benzos), also known as minor tranquilizers, are man-made pharmaceutical drugs that help slow down brain activity in the central nervous system and the messages traveling between the brain and the body. This is achieved by altering the activity of the neurotransmitter gamma-aminobutyric acid (GABA) that can trigger stress and anxiety reactions.
Benzos are some of the most widely prescribed medications in the United States. According to the National Center for Health Statistics (NCHS), Benzodiazepine is prescribed at about 66 million doctors’ appointments a year in the U.S.
The Use of Benzodiazepines
The U.S. Food and Drug Administration (FDA) has approved the use of benzodiazepines for the treatment of various medical conditions such as:
Generalized anxiety disorder
Social anxiety disorders
Seizure disorders such as epilepsy
Doctors are also known to prescribe these medications for various off label conditions, including:
Other sleep disorders
Alcohol withdrawal management
Types of Benzodiazepines
There are many different types of benzodiazepines that vary in terms of potency, how quickly the body absorbs them, and their uses. Although there are more than 2,000 different types of benzodiazepines produced, only around 15 are currently approved by the FDA in the United States. Some of the most common benzodiazepines are:
Most benzodiazepines are only recommended for periods of weeks or months to treat certain disorders. However, the dosage, frequency, and duration of treatment vary depending on the patient and the medical condition being treated.
Dangers of Benzodiazepines
Despite their tremendous medical benefits, benzodiazepines also carry a high risk of causing dependence and tolerance. The Food and Drug Administration (FDA) requires all benzodiazepine medications to include a black box warning to alert all consumers of its potential dangers.
While short-term use of this medication is considered safe, continued long-term use of benzodiazepines, even for a genuine health condition, can increase the risk of dependence and tolerance.
Although intentional misuse of prescription benzodiazepines is relatively uncommon among the general public, they should be used more cautiously in people with a history of drug use as they are the most at risk of developing a dependence. People who misuse benzodiazepines generally combine this medication with other drugs to enhance its effects. While taking too many benzodiazepines can be dangerous in itself, mixing them with alcohol or other substances can be fatal. According to the American Academy of Family Physicians (AAFP), an estimated 80% of all benzodiazepine misuse is part of polydrug misuse.
The consequences of forming a benzodiazepine addiction are many, including the risk of a fatal overdose and withdrawal symptoms. As such, it is crucial to discuss the risks of prescription benzodiazepines with your doctor if you have a history of drug use.
If you suspect yourself or a loved one to be struggling with benzodiazepine addiction or dependence, seek immediate treatment through an addiction specialist or talk to your physician for support and guidance.
Side Effects of Benzodiazepines
Similar to most medications, benzodiazepines come with their own set of side effects. The side effects of benzodiazepines may vary from person to person. The most common side effects of benzodiazepines include:
Impaired coordination (increasing the risk of falls and accidents)
Some of the more serious side effects of benzodiazepines include:
Delirium (especially among the elderly)
Risk of dependence and tolerance
All benzodiazepines can cause physical dependence. And as such, doctors do not recommend using benzodiazepines for more than 2 weeks. People who use benzodiazepines for longer may experience withdrawal symptoms if they cease using them abruptly.
Withdrawing from benzos can be a difficult and dangerous process. Patients who form a dependence will require a gradual tapering down of this medication under the careful supervision of health care professionals.
Long term use of benzodiazepines can cause symptoms of withdrawal such as:
Nausea and vomiting
Agitation and restlessness
Shortness of breath
Flushing of the skin
Benzodiazepine use for longer than 6 months can cause grand mal seizures and delirium upon abrupt cessation. The risk of withdrawal seizures is increased when you consume benzodiazepines with other medications that lower the threshold for seizures.
The severity of withdrawals is contributed by a variety of factors, including:
If you consume high doses of benzodiazepines
Type of benzodiazepine used
How long you’ve been taking them
The different types of benzos you are taking
Other types of medications used
History of substance use disorder
Whether you are quitting more than one substance at a time
One of the adverse effects of benzodiazepine misuse is an overdose.
Benzodiazepines carry an extremely low risk of acute toxicity when used alone. However, since they are generally used along with other types of medications and drugs with high misuse potential, this combination can enhance the toxic effects of benzodiazepines. This interaction can easily lead to a fatal overdose.
The symptoms of a benzodiazepine overdose can lead to:
Extreme sedation or drowsiness
The decrease in breathing rate
Loss of muscle control
Benzodiazepine overdose can be fatal in elderly patients and in people who take it along with alcohol or opioids. People who show signs of an overdose or an adverse reaction after taking benzodiazepines must seek immediate medical attention before symptoms worsen.
Other Risks of Benzodiazepines
Increased excitement, irritability, aggression, hostility, and impulsivity may occur in some patients who take benzodiazepines. Unfortunately, this paradoxical disinhibition can result in violent antisocial behaviors. This reaction is most commonly seen in children, the elderly, and people with developmental disabilities.
According to the National Institute on Drug Abuse (NIDA), benzodiazepine use is associated with the increase in emergency room visits, mental disorders, suicidal ideation, and substance use disorder (SUD).
According to the American Academy of Family Physicians (AAFP), around 4 million daily benzodiazepine users in the United States meet the criteria for substance dependence.
Other major risks associated with benzodiazepine use include:
Cognitive impairment due to acute adverse effects.
Risk of motor vehicle crashes while under the influence of benzodiazepines.
Hip fracture in elderly patients due to impaired coordination.
Combining Benzodiazepines with Other Drugs
Some people tend to combine benzodiazepines with other drugs such as alcohol, prescription pain medications, opioids, or other benzodiazepines in an attempt to enhance the effects of both or either of the drugs. Such a combination of benzodiazepines will only lead to a higher risk of fatal overdose, impaired cognition, and adverse effects such as acute anxiety. In fact, the risks of such a combination are even more severe than the risks of abusing them separately. So it is important to avoid the use of alcohol or other drugs while on prescription benzodiazepines. Make sure to inform your doctor if you’re on any other medications to avoid the risk of drug interactions.
Although benzodiazepines are effective in treating a wide range of medical and psychiatric conditions, caution must be exercised with their use, particularly when these medications are prescribed to patients with an active or remote history of substance misuse or addiction. The wide availability and its genuine medical use make it difficult to draw the line between use and misuse. So it is worth taking a closer look at the benzodiazepines you’re prescribed and how long they’re meant to be taken to avoid the adverse effects of this medication and the risk of dependence.
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