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Benzodiazepine Handbook: The Prescription Drug Danger

Drugs & Alcohol

Benzodiazepine abuse is on the rise in the United States. According to SAHMSA, between 1998 and 2008, the rise in treatment admissions for benzodiazepines was drastic. In 1998, there were 22,400, and in 2008, there were 60,200.

“Much attention has been paid to the explosion of prescription opioid prescribing and the associated morbidity and mortality. Much less attention has been paid to the shadow epidemic of benzodiazepine prescribing and its consequences.”

~ Dr. Gary Reisfield, Professor of Psychiatry, University of Florida

With all of the focus on the tragedies resulting from the ongoing opioid epidemic, many people forget that there is another kind of prescription medication that is commonly misused – benzodiazepines.

Every year, 1 out of every 20 Americans fills a benzodiazepine prescription.

Because medications in the benzodiazepine class are among the most-prescribed drugs in the United States, the sheer number of people who are addicted to and die from these medications should be a major cause of concern.

How big is the problem?

How big is the problem?

Every year, there are almost 200,000 NEW benzodiazepine abusers. Currently, about 30% of all fatal prescription drug overdoses in America are due to benzodiazepines.

Understanding what benzodiazepines are, what they do, and how they are abused is key to addressing what has been called the “benzodiazepine tsunami”.

What Are Benzos and How Are They Used?

What Are Benzos and How Are They Used?

First discovered in 1955, “benzo” prescription medications are psychiatric drugs that are considered to be minor tranquilizers. They have a number of legitimate medical uses, and are prescribed as treatment for:

  • Panic disorder and panic attacks
  • Generalized Anxiety Disorder (GAD) and other anxiety disorders
  • Depressive disorders
  • Insomnia and parasomnia
  • Convulsive epileptic seizures
  • Alcohol detoxification
  • Alcohol Withdrawal Syndrome
  • Benzodiazepine Withdrawal Syndrome
  • Muscle spasms
  • Pre-surgery anxiety
  • To produce amnesia during surgery
  • Dental phobia
  • Hallucination intoxication
  • Psychosis and some types of Delirium
  • Rapid eye movement behavior disorder
  • Restless leg syndrome
  • Obsessive-compulsive disorder (OCD)
  • To reduce the effects of electroconvulsive therapy

These drugs are among the most commonly prescribed medications in the United States today. They work by acting on the central nervous system. Because of this, they allow the muscles of the body to relax, and they cause a sedation effect. As a result, anxiety levels are lowered, people are able to sleep, and other medical goals are reached.

Unfortunately, people frequently abuse benzodiazepines. They may do this in a number of different ways. Sometimes people with prescriptions will abuse them because they don’t seem to be working any longer. However, there are those who will abuse benzos for the purpose of getting high.

What Are Some of the More Common Benzodiazepines Prescriptions?

What Are Some of the More Common Benzodiazepines Prescriptions?

Here is a list of benzodiazepines that are currently approved by the FDA for use in the United States:

  • Alprazolam ( Xanax)
    • Prescribed for: Anxiety, Panic Disorders and Anxiety Due to Depression
    • The most-prescribed and most-abused benzo
    • Alters chemicals in the brain that can lead to imbalance
  • Chlordiazepoxide (Librium)
    • Prescribed for: Severe Anxiety and Alcohol Withdrawal Syndrome
    • Also used to help with anxiety and fear prior to surgical procedures
    • May be used for additional conditions, determined by a doctor
    • Works by slowing down how quickly chemicals move in the brain
    • Aids in reducing muscle spasms and nervous tension
    • Causes severe sedation
    • The first benzodiazepine to be synthesized
  • Clobazam (Onfi)
    • Prescribed for: Anxiety and Epileptic Seizures
    • Affects the chemicals in the brain that can cause anxiety
    • Frequently used along with other drugs to aid in treating seizures
    • Approved for use in children who have Lennox-Gastaut Syndrome, a serious form of childhood epilepsy
    • Useful for helping in behavioral and developmental problems in children with this condition
    • May be used for additional purposes as determined by a doctor
  • Clonazepam (Klonopin)
    • Prescribed for: Panic Disorder, Akathisia, and Seizures
    • Affects unbalanced brain chemicals, due to the above conditions
    • Very useful in treating seizure disorders
    • Also known as an anti-epileptic drug
    • Frequently used to treat adults with agoraphobia
    • Starts working within an hour after ingestion
  • Clorazepate (Tranxene)
    • Anxiety, Insomnia, Alcohol Withdrawal, and Epileptic Seizures
    • Often combined with other medications for those suffering from seizures
    • Works by slowing down the central nervous system
    • Should not be used in combination with Flumazeninl
    • Has an extremely long half-life – up to 179 hours
  • Diazepam (Valium)
    • Prescribed for: Anxiety, Panic Attacks, Insomnia, Alcohol/Opioid/Benzodiazepine Withdrawal, Tetanus, Eclampsia, Spastic Paresis, Stimulant Overdoses
    • Directly effects the chemicals in the brain that lead to anxiety
    • Works quickly, bringing fast relief for panic attacks
    • Can be used along with other medications to treat seizure disorders
    • Was the most prescribed drug in the United States, 1969-1982
  • Estazolam (ProSom)
    • Prescribed for: Insomnia
    • May be useful for other conditions that a doctor may deem necessary
    • Depresses the central nervous system to cause drowsiness
    • Not indicated during pregnancy
    • Should not be used along with clozapine or sodium oxybate
    • Increases duration of sleep by reducing the number of nighttime awakenings
  • Flunitrazepam (Rohypnol)
    • Known as the “date rape drug”
    • This benzodiazepine may also be known by the street names, Roofies, Ruffles, Forget Me Drug, Mexican Valium
    • Has properties that are similar in nature to Valium
    • Was once used for the short-term treatment of insomnia
    • Has been used during surgical procedures, and to aid in inducing anesthesia
  • Flurazepam (Dalmane)
    • Prescribed for: Mild to Moderate Insomnia
    • This benzodiazepine may also be used to treat other conditions
    • Depresses the central nervous system to cause drowsiness
    • It is not indicated for pregnant women
    • May not be used with some other medications, herbal remedies or supplements
    • Can lead to depression, suicidal behaviors, COPD and dependence
    • Has an extremely long half-life – up to 250 hours
  • Lorazepam (Ativan)
    • Prescribed for: Anxiety, Insomnia, Epileptic Seizures, Alcohol Withdrawal, Surgical Procedure Amnesia, and Nausea/Vomiting due to chemotherapy
    • May also be used for additional purposes, as deemed necessary by a doctor
    • Is extremely habit-forming and should never be used without a prescription
    • Can easily lead to addiction, overdose or death
    • Frequently sold online by unapproved vendors
    • The second-most-prescribed benzo
  • Midazolam (Versed)
    • Prescribed for: Anxiety, Insomnia, Anesthesia, and Medical Procedure Sedation
    • Is a central nervous system depressant
    • Frequently given to lead to memory loss after surgical procedures
    • May be used in children, but not tested for use prior to six months old
    • Not indicated for use during pregnancy
    • Not enough data exists to indicate safety during breastfeeding
    • On the World Health Organization’s List of Essential Medicines
  • Nitrazepam (Alodorm)
    • Prescribed for: Insomnia and Age-Dependent Epilepsy
    • Also goes under the brand name Mogadon, among other brand names
    • As a benzodiazepine, produces a hypnotic and sedating effect
    • Also useful for short-term relief from anxiety that may be severe and disabling
    • Can produce amnesia
    • Useful for its muscle relaxing qualities
    • Particularly unsuitable for the elderly, because it can lead to a misdiagnosis of brain disease
  • Oxazepam (Seresta)
    • Prescribed for: Anxiety, Insomnia, Alcohol Withdrawal
    • Also goes under the brand name, Serax
    • May have severe side effects
    • Currently not available in the United States
    • Originally marketed in 1965
  • Quazepam (Doral)
    • Prescribed for: Insomnia
    • Not for use in people who suffer from sleep apnea or another chronic breathing disorder
    • May cause sleepwalking behaviors and amnesia, even with appropriate use
    • Should not be used by those with liver or kidney disease
    • Causes significantly less drug tolerance and withdrawal symptoms than other benzodiazepines
  • Temazepam (Restoril)
    • Prescribed for: Severe Insomnia
    • Useful in treating those who have trouble falling asleep or staying asleep
    • Works by slowing down the central nervous system
    • Not for use during pregnancy, and can lead to life-threatening problems in newborns
    • Used by the US Air Force to ensure adequate rest for pilots and special-duty personnel
  • Triazolam (Halcion)
    • Prescribed for: Jet Lag, Medical/Dental Procedure Anxiety
    • Not for use by those with severe mental disorders
    • Not for use during pregnancy or breastfeeding
    • May not be used with certain herbal or dietary supplements
    • Puts a person to sleep for no more than 2 hours

Side Effects Associated with Short-Term Benzo Use

Side Effects Associated with Short-Term Benzo Use

Most experts consider benzodiazepines to be effective and safe when used short-term. However, as might be expected with a tranquilizing medication, there are certain possible side effects:

  • Aggression
  • Dizziness
  • Drowsiness
  • Loss of coordination
  • Difficulty concentrating
  • Confusion
  • Anterograde amnesia – an inability to form new memories
  • Decreased alertness
  • Impaired ability to drive or operate machinery
  • Increased likelihood of accidents
  • Sexual dysfunction.
  • Depression
  • Loss of inhibition
  • Low blood pressure
  • Respiratory depression
  • Liver toxicity
  • Nausea
  • Decreased appetite
  • Blurred vision
  • Nightmares
  • Depersonalization
  • Detachment from reality
  • Euphoria

This euphoria is one of the factors that drive benzodiazepine abuse.

Side Effects Associated with Long-Term Benzodiazepine Use

Long-term benzodiazepine use is not recommended, because it can have serious negative effects on a person’s mental and physical health.

  • Cognitive problems – including impaired memory, attention span, verbal learning, motor skills, and spatial reasoning
  • Sleep disturbances – including shortened sleep time, delayed/decreased REM sleep, increased alpha/beta activity, decreased K complexes/delta activity, and impaired “deep sleep”
  • Mental disorders – depression, anxiety, PTSD, agoraphobia, panic attacks, hallucinations, delusions, and suicidal ideation
  • Immune system suppression
  • Possible cancer risk – especially of the bladder, breast, bowel, lung, and brain
  • Substance abuse disorder – increased risk of dependence and addiction, with life-threatening withdrawal symptoms

Why Are Benzodiazepines So Addictive?

Why Are Benzodiazepines So Addictive?

“This was a nail-in-the-coffin study to show that activity of dopaminergic neurons leads to synaptic adaptation that is involved in addiction. This is why addiction is so difficult to treat. Even if you clear the drug from the body, there are long-lasting changes in brain architecture.”

~ Dr. Christian Lüscher, University of Geneva

Benzodiazepines are considered to be among the most-addictive substances in the world, after heroin, cocaine, and nicotine.

Just like other substances of abuse – opioids, alcohol, stimulants, cannabinoids – benzodiazepines are addictive because they affect dopamine production within the brain. Dopamine is a neurotransmitter associated with pleasure, reward, and motivation. When any activity – sex, eating, substance abuse – causes excessive dopamine levels, the person is, in essence, “trained” to repeat that behavior.

Addiction happens in stages.

First, there is normal use. A person takes their benzo medication as precisely as prescribed. However, over time, or at too high a dose, brain chemistry is affected. Recent research even suggest that simply taking benzos “as needed” can promote misuse.

Eventually, a tolerance develops. This means that the person’s body has become accustomed to the medication. It takes more and more of the drug to achieve the same effect. Dosages must be increased.

Next comes dependence. Artificially-elevated dopamine levels cause brain to stop manufacturing dopamine naturally. This means that the drug abuser is unable to experience pleasure, enjoy, or even feel “normal” without the presence of drug. Now, the user NEEDS the drug to function at all.

In other words, where once the person took their benzo medication to feel good, now they must take it to keep from feeling bad.

In fact, within just a few hours of their last dose, a benzodiazepine-dependent person can go into withdrawal if the drug is not available. The symptoms of benzodiazepine withdrawal are so harshly unpleasant and dangerous as to be life-threatening.

That bears repeating – trying to quit benzo medications abruptly without medical supervision can be fatal.

The mental and physical pain of withdrawal is one of the factors that drives drug addiction and relapse.

What Are the Symptoms of Benzodiazepine Withdrawal?

Benzodiazepine withdrawal syndrome is a potentially-dangerous medical condition that results when benzos that have been used medically or recreationally are reduced or discontinued.

Withdrawal symptoms can begin to present in as little as 24 hours after the last dose.

Dosage reduction can result in the following withdrawal symptoms:

  • Accelerated heartbeat
  • Agitation
  • Akathisia (mental distress and restlessness)
  • Aphasia (inability to use language)
  • Anxiety
  • Increased or lowered blood pressure
  • Blurred/double vision and/or dilated pupils
  • Chest pains
  • Depersonalization
  • Depression
  • Dizziness
  • Dry mouth
  • Dysphoria (extreme feelings of dissatisfaction)
  • Electric shock sensations
  • Elevated or low blood pressure
  • Fatigue
  • Flu-like symptoms
  • Gastrointestinal discomfort
  • Hearing loss
  • Headache
  • Hot/cold flashes
  • Hypnagogia hallucinations during waking or falling asleep
  • Hypochondria
  • Indecision
  • Insomnia
  • Impaired concentration and memory
  • Loss of appetite
  • Metallic taste
  • Mood swings
  • Muscular aches/spasms/cramps
  • Nausea/vomiting/diarrhea
  • Nightmares
  • Obsessive Compulsive Disorder (OCD)
  • Panic/terror attacks
  • Paraesthesia (“pins and needles sensation”)
  • Paranoia
  • REM sleep rebound
  • Restless legs syndrome
  • Sensitivity to light, sound, touch, taste, and smell
  • Sweating
  • Stiffness
  • Suicidal thoughts
  • Tinnitus
  • Tremor
  • Urinary changes
  • Weight loss

The symptoms are much more severe when benzo medications are discontinued abruptly:

  • Autonomic imbalance POSSIBLY FATAL
  • Catatonia (rigid immobility and stupor) POSSIBLY FATAL
  • Confusion
  • Convulsions POSSIBLY FATAL
  • Coma
  • Delirium tremens POSSIBLY FATAL
  • Delusions/Hallucinations/Psychosis
  • Hyperthermia (elevated body temperature)
  • Homicidal thoughts/Violent urges
  • Mania (abnormal activity level)
  • Organic brain syndrome (delirium)
  • Post-Traumatic Stress Disorder (PTSD)
  • Suicide

It is recommended that benzodiazepine dosages should be gradually tapered, rather than abruptly discontinued. Because of all of the possible complications, benzo withdrawal should ONLY occur under direct medical supervision.

Acute benzo withdrawal last approximately 2 months. However, some withdrawal symptoms will last up to a year.

Substances to Avoid During Benzodiazepine Withdrawal

During benzo withdrawal, there are several substances that should be avoided because they can worsen the symptoms and increase the risks:

  • Alcohol – cross-tolerant with benzos, single greatest predictor of withdrawal failure
  • Antipsychotics – increase the risk of seizures
  • Barbiturates – cross-tolerant with benzos
  • Other Benzodiazepines – even after discontinuation, re-exposure can trigger withdrawal syndrome
  • Bupropion – increases the risk of seizures
  • Caffeine – increases the risk of seizures, and as a stimulant worsens withdrawal
  • Fluoroquinolone Antibiotics – quadruples the risk of central nervous system toxicity, can trigger acute withdrawal symptoms
  • Tramadol – increases the risk of seizures

Statistics about Benzodiazepine and Prescription Drug Use and Abuse in the United States

The Centers for Disease Control and Prevention and the annual Medical Expenditures Panels Survey suggests a problematic pattern:

  • 1996-2016: the number of US adults possessing at least one benzo prescription increased from 8.1 million to 13.5 million.
  • This is a 67% increase.
  • During that same time, the amount of medicine contained in those benzo prescriptions also DOUBLED.
  • The rate of deaths involving benzo drugs more than quintupled, rising from .58 deaths/100,000 people in 1999 to 3.07 by 2013.
  • Likewise, the number of overdose deaths involving benzodiazepines also quintupled between 2001 and 2014, according to the National Institute on Drug Abuse.

Polydrug Abuse: Benzodiazepines, Opioids, and Alcohol

“It is nothing short of a public health crisis when you see a substantial increase of avoidable overdose and death related to two widely-used drug classes being taken together.”

~ Dr. Robert Califf, FDA Commissioner

75% of all drug overdoses—and 98% of those that are fatal —involve more than one substance.  Benzodiazepines, alcohol, and opioids are all central nervous system (CNS) depressants, and their effects are greatly magnified when they are used together.

In 2001, just 9% of patients who were prescribed opioid painkillers also used a benzodiazepine-class medication. But by 2013, dual use had nearly doubled, to 17%.

Other statistics about concurrent benzo/alcohol/opioid use include:

  • Almost 75% of heroin users have used benzos within the past year.
  • 25% use benzos DAILY.
  • One-third heroin users have had a benzodiazepine prescription within the 30 days.
  • 40% of clients in opioid replacement therapy (ORT) – either suboxone or methadone – have had a benzodiazepine prescription within the last year.
  • This is 8X the rate for the population as a whole.
  • Up to 50% of methadone clinic new admissions will also need to detoxify from benzos.
  • 51%-70% of methadone ORT clients test positive for benzos.
  • Nearly half of methadone ORT clients who also abuse benzos do so to “produce an intense, exciting experience.”
  • Almost 75% of methadone ORT clients who are also benzo users say that diazepam enhances methadone’s effects.
  • 94% of methadone patients will misuse sedatives within their lifetime.
  • 40%-60% of chronic pain patients will use benzos regularly.
  • 1 out of every 6 people in opioid treatment also test positive for benzos.
  • Heroin addicts self-report stronger, longer-lasting effects when co-using heroin and flurazepam intravenously.
  • 80% of deaths involving heroin, methadone, or buprenorphine also involve benzodiazepines.
  • Benzo/opioid polydrug abuse results in a TRIPLED risk of psychiatric hospitalization.
  • It also DOUBLES the chances of needing a prescription for suicidal ideation.
  • Between 2005 and 2011, benzo/opioid polydrug abuse caused almost 250,000 trips to the Emergency Room.
  • There were also nearly 164,000 ER visits for benzo/alcohol abuse during that same timeframe.
  • Using all 3 substances resulted in another 43,000 ER trips.
  • Roughly 40% of the ER visits resulted in a “serious outcome”.

Special Considerations for Elderly Patients

“There is absolutely no doubt these drugs have dangerous side effects. It’s important for people to understand that they can be addictive, and increase the risk of confusion and falls.”

~ Dr. Gisele Wolf-Klein, a geriatric specialist at North Shore-LIJ Health System

A 2014 study published in the British Medical Journal and conducted by scientists at the University of Bordeaux suggests a link between the longer-term use of benzodiazepines– three months or longer – to an increased risk of brain disease.

Older patients who were prescribed benzos for over three months had a 51% higher likelihood of developing Alzheimer’s disease.

And, in 2012, the American Geriatrics Society added benzodiazepine to a list of “potentially inappropriate” medications for senior citizens due to increased risks of confusion, dizziness, and falls.

Slang and Street Names for Benzodiazepines

Benzo abusers will frequently use codenames when they message or speak about their habit. Familiarizing yourself with the most-common nicknames for the different benzos helps you recognize when a loved one has a problem.

Here is a short list of some popular benzodiazepine medications, their brand names, and their most-frequently used nicknames:

  • Alprazolam/Xanax:
    • Bars
    • Bennies/Phennies/Zannies
    • Xs
    • Phennies
    • Peanuts
    • Ladders/Ludes
    • Footballs/Goofballs
    • Downers
    • Christmas Trees
  • Clonazepam/Klonopin:
    • K/Pin/K-Pin
    • Super Valium
  • Zolpidem/Ambien:
    • A Minus
    • Zombie Pills
    • Tic-Tacs
    • Sleep Easy/EZ
    • No-Gos
  • Lorazepam/Ativan:
    • Candy
    • Control
    • Nerve Pills
    • Stupefy
    • Emotion
    • Roches
    • R2
    • Roofies
    • Heavenly Blues
  • Diazepam/Valium:
    • Tranks
    • Yellow or Blue Vs
    • Drunk Pills
    • Sleep Always
    • Foo Foos
    • Old Joes
    • Dead Flower Power

If you overhear someone close to you – partner, spouse, child, close friend – using any of these slang terms, it may warrant closer attention. Although use of these terms does not absolutely mean they are abusing benzodiazepines, it DOES mean that you need to have a frank conversation. NEVER ignore any warning signs of benzo abuse.

Prescription Drug Abuse Problem in the United States

There is no question that there is a serious addiction epidemic sweeping the country. In fact, this has been the case for several years. Even though it seems that there are better ways to treat addiction today, it doesn’t seem to be going away. Benzodiazepines and other drugs, such as opioids, appear to be leading the charge.

According to the CDC:

  • More than 6 out of 10 overdose deaths involve an opiate drug.
  • Since 1999, the number of overdose deaths involving opioids has quadrupled.
  • More than half a million people died from drug overdoses from 2000 to 2015.
  • Every day, 91 people in the United States die from an opioid overdose.
  • The amount of prescription drugs sold in the U.S. since 1999 has almost quadrupled.

Clearly, this problem is here to stay. This is why it’s so important to reach individuals regarding the problem of prescription drug abuse. For many benzodiazepines have become their drugs of choice. These drugs are dangerous. They can easily lead to addiction, and eventually lead to an overdose when they are misused.

How are Prescription Benzos Abused?

Benzodiazepines can be abused in a number of different ways. What’s most interesting is that most of the time, people don’t realize they’re abusing them. This is commonly seen in elderly people who have been prescribed benzos for anxiety or insomnia.

Because benzodiazepines are prescription drugs, they are viewed as being safe. After all, a doctor would never prescribe anything dangerous, right? All benzo medications have warnings on their labels indicating the risk of abusing them. Frequently, those labels are completely ignored.

Benzodiazepines can be abused by:

  • Taking too many doses too closely together
  • Taking more than the required prescription because the prescribed dose doesn’t appear to be working
  • Crushing the pills and snorting them or injecting them
  • Taking a benzodiazepine that has not been prescribed for you
  • Mixing benzos with other drugs or alcohol, as was previously discussed

No matter how these prescription drugs are abused, it is very dangerous. Continual abuse of them is very likely to lead to a benzodiazepine addiction.

Causes for Prescription Drug Abuse

There are a number of factors that could potentially lead to benzodiazepine abuse. Some people are simply predisposed to drug abuse and even addiction. Someone with a history of abuse is likely to have a tendency to abuse benzodiazepines. This is true even if that person has a prescription.

Environmental factors also play a big role in whether or not someone will abuse benzos. Having a low socioeconomic status and peer pressure are major causes of this type of prescription drug abuse. Also, someone who is unemployed is at a high risk for benzo abuse as well. As you might assume, you could also be at risk for prescription drug abuse if you have a family history of it. None of these risk factors should be overlooked, and they are all important.

Treating Prescription Drug Abuse for Those Who Misuse Benzos

Fortunately, there are ways to get help if you are affected by benzo abuse or addiction. This type of prescription drug abuse should not be handled on one’s own. To take matter into your own hands could end up being detrimental to your health and well-being. It can easily lead to a drug relapse, and possibly even an overdose.

Most people find that they require time in an inpatient drug rehab facility to stop using benzodiazepines. There may be a time of benzo detox that needs to take place as well. Detoxification will help to support the patient during withdrawal. Drug treatment will assist with the psychological part of the addiction. Both are vital for a successful recovery.

Are You Abusing Benzodiazepines?

If you’re abusing benzodiazepines, you have a problem that should not be ignored. It may be tempting for you to just overlook the problem, and perhaps address it at another time. You also may be tempted to just stop using benzos abruptly. Both are bad ideas.

The fact is that you need to get help. Benzodiazepine abuse or addiction should not be handled on your own. Professional assistance is available to you immediately.

Remember, benzodiazepine abuse is a serious issue that can have long-lasting consequences. Reach out for help today from Northpoint Recovery, and get started on the road to recovery.

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By |2021-01-28T15:55:10+00:00August 19th, 2017|

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