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There are more than 15 approved prescription benzodiazepine medications in the United States today used to treat a variety of physical and psychiatric symptoms.[1] Benzodiazepines are central nervous system depressants with sedative, hypnotic, anticonvulsant, amnesiac, muscle-relaxing, or anxiety-relieving properties. They are generally taken as a tablet or capsule that is swallowed, although some are dispensed intravenously.

Benzodiazepines primarily affect the inhibitory neurotransmitter gamma-aminobutyric acid, or GABA, and its receptor sites in the brain. GABA is a kind of natural tranquilizer with sedative and calming effects. Benzodiazepines slow or stop neural impulses that may produce anxiety or motor neurons responsible for epileptic seizures. Benzodiazepine medications are intended for short-term use only, as they are considered highly addictive.

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Xanax Is the Most Prescribed Psychiatric Drug of 2013, Ativan the Fifth Most and Valium the Ninth[2]

Xanax, Valium and Ambien are household names. These drugs are widely popular, as they are regularly prescribed. This may increase their accessibility and make them easier to obtain and misuse, thereby increasing the rates of addiction to these medications.

Benzodiazepine prescriptions rose by a rate of 12.5 percent a year between the years 2002 and 2009.[3] Some of the most popular benzodiazepine medications and their name brands as well as their rate of prescription in the United States in 2011 include:

  • Alprazolam (Xanax): 49 million prescriptions
  • Lorazepam (Ativan): 27.6 million prescriptions
  • Clonazepam (Klonopin): 26.9 million prescriptions
  • Diazepam (Valium): 15 million prescriptions
  • Temazepam (Restoril): 8.5 million prescriptions[4]

Most benzodiazepine medications usually start working quickly on symptoms of panic and anxiety, providing almost immediate relief, making them popular anti-anxiety or panic disorder medications. They may be used as adjunct medications for mood disorders until other long-term medications take effect. Some benzodiazepines are better sleep aids, or muscle relaxants, while still others are used prior to surgery or medical procedures for their sedative effects and the short-term memory loss they can induce. Different benzodiazepine medications may work on different receptors in the brain.

Chlordiazepoxide, brand name of Librium, is used for the treatment of alcohol withdrawal symptoms that can include seizures. Benzodiazepine medications with anti-anxiety effects are alprazolam, diazepam, lorazepam, clorazepate, and chlordiazepoxide, while sedative-hypnotic benzodiazepines include temazepam, estazolam, triazolam, and flurazepam. Diazepam is a muscle-relaxing benzodiazepine as well as an anticonvulsant like clonazepam. Midazolam is used in a hospital setting as an adjunct medication during medical procedures or prior to surgery.

Another anti-insomnia medication that works on GABA receptors much in the same way as benzodiazepine medications is zolpidem or Ambien, which is considered a non-benzodiazepine sleep aid, sometimes called a Z-drug. While it is technically not a benzo, and rather a sedative, it is often treated in the same manner as benzodiazepines. In the United States in 2010, zolpidem prescriptions reached 38 million, making Ambien and other zolpidem medications some of the most prescribed sleeping pills in the country.[5]

Benzodiazepines are considered Schedule IV drugs under the Controlled Substances Act by the Drug Enforcement Agency, or DEA, due to their medicinal value and estimated potential for abuse and addiction.

An Estimated 14 Percent of Those Using Prescription Medications for Non-Medical Purposes in the Past Year Met the Criteria for Abuse or Dependence[6]

Most benzodiazepines are only meant to be taken for a few weeks for the relief of acute symptoms, and they are not intended to be long-term solutions. The U.S. Food and Drug Administration (FDA) warns that using Xanax in doses over 4 mg/day for longer than 12 weeks can increase the odds for developing a dependency.[7] Even when taken as directed, the body can build up a tolerance to benzodiazepines, meaning that you will need to take more of the drug in order to obtain the desired effects. Over time, this can develop into both a physical and psychological dependence, wherein the brain depends on these drugs. You may experience drug cravings and withdrawal symptoms when the drugs leave your bloodstream, which may encourage non-medical use, or abuse, of these substance, thus heightening the chance for physical and emotional dependence and increasing the odds for developing an addiction.

Withdrawal symptoms may occur as a rebound effect as your brain struggles to regain a balance without the chemical or drug interactions. Symptoms may include insomnia, restlessness, anxiety, irritability, muscle weakness or tension and aches, as well as a racing heart. Withdrawal symptoms may vary in severity, depending on your level of dependency, the half-life of the benzodiazepine you take, and your method of ingestion as well as your personal genetic makeup.

Approximately 43 percent of those taking diazepam for eight months or longer experienced withdrawal side effects when they stopped the medication, and 35 percent of those taking between two and 10 mg/day of alprazolam for eight weeks did as well.[8] Benzodiazepines may be used as a method of self-medicating an undiagnosed anxiety, panic, or mood disorder. Users may become depressed or notice a return of symptoms without the drug, thereby creating a psychological draw to continue to use them even if they aren’t considered medically necessary or prescribed long-term.

It is not recommended to stop taking a benzodiazepine medication suddenly without help due to the uncomfortable withdrawal symptoms. Instead, medical professionals will likely set up a slow and controlled taper off the drug in order to safely detox from it. Even with a legitimate prescription, you can develop a dependence or addiction to benzodiazepine medications requiring medical intervention or specialty treatment.

Dependence on these medications is not just an issue in the United States, but also a global issue. For example, an estimated 1.1 million people in Germany are thought to be dependent on benzodiazepines or medications containing zolpidem or zopiclon, according to the German Center for Addiction Issues (DHS).[9]

In 2012, 8.5 Percent of Americans Over 12 Were Classified with a Substance Abuse Disorder[10]

Dependence differs from addiction. While someone who is addicted to a substance is dependent on it, a dependence does not always indicate addiction. Compulsive drug-seeking behavior is necessary to diagnose addiction, for instance. A substance use disorder, or addiction, is considered a brain disease that affects the reward and motivation centers in the brain. Someone who is addicted to a substance will spend an excessive amount of time seeking out the drug, using it, and recovering from its effects. Addicts may also take the drug regardless of or in spite of any negative physical and interpersonal consequences, and withdraw from social situations and activities that were previously enjoyed. Someone who suffers from a substance abuse disorder also may take more of the drug than intended, for longer periods of time, and may have made several unsuccessful attempts to stop taking it.

Tolerance and withdrawal are also symptoms of a substance abuse disorder that apply to all types of benzodiazepines. In 2013, an estimated 423,000 Americans aged 12 and older were considered to suffer from tranquilizer abuse or dependency, while 99,000 suffered from sedative abuse or dependency in the year prior to the National Survey on Drug Use and Health (NSDUH).[11]

Benzodiazepine Deaths Increased Fivefold from 1999 to 2009; Alprazolam Death Rates Rose 233.8 Percent[16]

The Centers for Disease Control and Prevention (CDC) has labeled prescription drug abuse an epidemic, with drug overdose being the leading cause of injury death in 2012.[17] Prescription drugs, or pharmaceuticals, were involved in 51.8 percent of all drug overdose fatalities in 2013, with 30.6 percent of those involving benzodiazepine medications.[18] Benzodiazepines, as central nervous system depressants, reduce heart rate, blood pressure, body temperature, and slow breathing. These can lead to respiratory failure, cardiac complications, or hypotension, which may have life-threatening consequences.

Benzodiazepines are commonly mixed with other drugs such as opioids or alcohol, which increases the chances for a potentially fatal outcome. Overdoses involving more than one drug accounted for 71 to 98 percent of all fatal overdoses.[19] Opioids also affect respiration, and alcohol is another central nervous system depressant that can multiply the effects of benzodiazepines with tragic results.

Signs of a benzodiazepine overdose include extreme drowsiness, severe confusion, weakness, shallow or trouble breathing, irregular heart rate, loss of consciousness, psychosis, hallucinations, lack of coordination, anxiety, and agitation. A benzodiazepine overdose is a medical emergency, and you should seek immediate medical attention if you suspect one.

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Between 2005 and 2011, Almost One Million Emergency Department Visits Involved Benzodiazepines[20]

Benzodiazepine abuse may cause a variety of side effects that may include drowsiness, dizziness, blurred vision, slurred speech, vertigo, poor concentration, short-term memory loss, muscle weakness, and impaired motor control, which may also indicate over-sedation. Emergency department (ED) visits involving benzodiazepines between 1999 and 2009 increased 89 percent.[21] Furthermore, the Drug Abuse Warning Network (DAWN) report of 2010 indicated that the following benzodiazepines were involved in ED visits:

  • Alprazolam: 124,902 ED visits
  • Clonazepam: 62,811 ED visits
  • Lorazepam: 36,675 ED visits
  • Diazepam: 26,860 ED visits[22]

In 2010, the DAWN report also showed that 64,175 ED visits involved the non-benzodiazepine insomnia medication zolpidem – one-third of these visits were related to overmedication, and 57 percent of the ED visits involved another pharmaceutical as well.[23] Benzodiazepine and non-benzodiazepine sleep aid abuse and misuse can be dangerous and may require specialty treatment in a comprehensive care facility in order to successfully detox and recover from the emotional and physical effects of the drug.

Black Bear Lodge offers a private, serene and supportive environment, staffed with highly trained medical professionals who are educated in evidence-based treatment models and dual diagnosis care. Mood, panic, anxiety, and sleep disorders that are often treated with benzodiazepines, and non-benzodiazepine sleep aids, can also be addressed with behavioral therapies and adjunct medications that may be safer to use long-term. Half of all drug abusers also battle mental illness, and half of those suffering from a severe mental illness also abuse substances.[24] Substance abuse can interfere with the treatment of a mental health disorder just as it can exacerbate its symptoms, and both issues need to be treated simultaneously with integrated care methods for the best results.

Citations

[1] (Oct. 2013). “Benzodiazepines.” Center for Substance Abuse Research (CESAR). Accessed March 30, 2015.

[2] Grohol, John M., Psy. D. (2014). “Top 25 Psychiatric Medication Prescriptions for 2013.” Psych Central. Accessed March 30, 2015.

[3] American Academy of Pain Medicine (AAPM). (March 2014). “Prescriptions for Benzodiazepines Rising and Risky When Combined With Opioids, Researchers Warn.” Science Daily. Accessed March 30, 2015.

[4] (Jan. 2013). “Benzodiazepines.” Drug Enforcement Administration (DEA). Accessed March 30, 2015.

[5] (April 2011). “The Use of Medicines in the United States: Review of 2010.” IMS Institute for Healthcare Informatics.

[6] (Nov. 2014). “From the Director. National Institute on Drug Abuse (NIDA). Accessed March 30, 2015.

[7] Laughren, Thomas P. (Aug.2011). “Xanax.” U.S. Food and Drug Administration (FDA). Accessed March 30, 2015.

[8] Pomerantz, Jay M., MD. (Aug 2007). “Risk Versus Benefit of Benzodiazepines.” Psychiatric Times. Accessed March 30, 2015.

[9] Institute for Quality and Efficiency in Health Care (IQWiG). (Nov. 2013). “Using Medication: What Can Help When Trying to Stop Taking Sleeping Pills and Sedatives.” Informed Health Online. Accessed March 30, 2015.

[10] (Oct. 2014). “Mental and Substance Abuse Disorders.” Substance Abuse and Mental Health Services Administration (SAMSHA). Accessed March 30, 2015.

[11] (Sept. 2014). “Results From the 2013 National Survey on Drug Use and Health: Summary of National Findings.” Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed March 30, 2015

[12] (Jan. 2013). “Benzodiazepines.” Drug Enforcement Administration (DEA). Accessed March 30, 2015.

[13] (Sept. 2014). “Results From the 2013 National Survey on Drug Use and Health: Summary of National Findings.” Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed March 30, 2015

[14] Maxwell, Jane Carlisle, PhD. (Nov. 2006). “Trends in the Abuse of Prescription Drugs.” The Gulf Coast Addiction Technology Transfer Center (GCATTC). Accessed March 30, 2015.

[15] (Sept. 2014). “Results From the 2013 National Survey on Drug Use and Health: Summary of National Findings.” Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed March 30, 2015

[16] Jann, M., Kennedy, WK., Lopez G. (Feb. 2014). “Benzodiazepines: A Major Component in Unintentional Prescription Drug Overdoses With Opioid Analgesics.” Journal of Pharmacy Practice. Accessed March 30, 2015.

[17] (Oct. 2014). “Prescription Drug Overdose in the United States: Factsheet.” Centers for Disease Control and Prevention (CDC). Accessed March 30, 2015.

[18] Ibid.

[19] Comer, Sandra D., Jones, Jermaine D., Mogali, Shanthi. (Sept. 2012). “Polydrug Abuse: A Review of Opioid and Benzodiazepine Combination Abuse.” Drug and Alcohol Dependence. Accessed March 30, 2015.

[20] Substance Abuse and Mental Health Services Administration (SAMSHA). (Dec. 2014). “The DAWN Report: Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious ED Visit Outcomes.” Drug Abuse Warning Network (DAWN). Accessed March 30, 2014.

[21] Jann, M., Kennedy, WK., Lopez G. (Feb. 2014). “Benzodiazepines: A Major Component in Unintentional Prescription Drug Overdoses With Opioid Analgesics.” Journal of Pharmacy Practice. Accessed March 30, 2015.

[22] (Jan. 2013). “Benzodiazepines.” Drug Enforcement Administration (DEA). Accessed March 30, 2015.

[23] Substance Abuse and Mental Health Services Administration (SAMHSA). (Aug. 2007). “The DAWN Report: Emergency Department Visits Attributed to Overmedication That Involved the Insomnia Medication Zolpidem.” Drug Abuse Warning Network (DAWN). Accessed March 31, 2015.

[24] Duckworth, Ken, MD., Freedman, Jacob L., MD. (Jan. 2013). “Mental Illnesses: Dual Diagnosis: Substance Abuse and Mental Illness.” National Alliance on Mental Illness (NAMI). Accessed March 30, 2015.