In the current conversation about prescription drug abuse, benzodiazepines get second billing. It’s unfair for benzodiazepines to be out of the limelight – these drugs, which include Xanax and Valium, have a strong risk for abuse and bring on long-term psychological symptoms.
While coverage of the prescription painkiller epidemic rightly tops conversations, there also are problems with benzodiazepine abuse. Important medical uses exist for this class of drugs, but they are intended for limited use. Unfortunately many people prescribed these drugs don’t know about the dangers of taking them for too long or at higher doses. In addition, many people misuse benzodiazepines because they believe they are safe, and the drugs are tied to the painkiller epidemic as well, because they intensify the feeling of opiates.
Medical Uses for Benzodiazepines
Benzodiazepinesare a class of drugs that relieve anxiety, control muscle spasms, prevent seizures and promote sleep. They are used in the treatment of a variety of anxiety-based disorders as well as insomnia and seizures.The drugs also may treat panic attacks and alcohol withdrawal. When patients take them for longer than recommended they may experience lingering psychological symptoms, such as depression, when they stop taking the drug. The also must step down gradually to avoid dangerous withdrawal symptoms.
The most commonly prescribed benzodiazepines are Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam). When possible, physicians should prescribe drugs that are less addictive than benzodiazepines. Aside from being highly addictive, the majority of medications in this category must not exceed maximum recommended doses. Therefore, someone with a lifelong disorder like generalized anxiety disorder— would develop a tolerance to a benzodiazepine like Xanax and the drug would no longer be effective. Thus, benzodiazepine drugs are generally not the first in line for treatments if something else is available.
Tolerance to benzodiazepines occurs after regular use, and in some patients, it only takes around a month. A 2008 review of benzodiazepine prescribing habits revealed 112.8 million prescriptions were filled in the prior year: primary care doctors prescribed 55% of them, psychiatrists prescribed 16% and other specialists prescribed the remaining 29%. With so many types of physicians prescribing benzodiazepines, it’s likely many of them miss the signs of a patient’s growing dependence or are unaware of doctor shopping habits that allow patients to sell pills on the black market. Even when benzodiazepines are taken at therapeutic doses, patients still develop a physical dependence. That’s why it’s important to only take them for a short time. People who are dependent and want to stop taking benzodiazepines must wean off them gradually under the supervision of a medical professional. Stopping the drug abruptly puts a person at risk of life-threatening seizures, tremors and muscle cramps.
Known on the street as “nerve pills,” “mother’s little helpers,” “downers,” “benzos” and “valley girls,” many people use benzodiazepines to get high, and they develop tolerance and dependency as their addiction grows. For this reason, benzodiazepines are a gateway drug because many people move on to harder substances when exceedingly high doses of the drugs no longer produce a good high for them.1
Of course, not all benzodiazepines are available by prescription; some drugs are illegal in the United States. Rohypnol — often known as the date rape drug — is linked to many sexual assaults.Other popular benzodiazepines, Xanax and Halcion, contribute to violent behavior in some people.
The History of Benzodiazepines
Benzodiazepines entered the medical field in the 1950s. By the mid-1970s, benzos were popular for treating depression and anxiety, with 103 million benzo prescriptions filled in 1975 in America alone. As reports of brain damage and addiction surfaced physicians began scaling back on benzo prescribing. Since the 1970s, however, benzo use has cycled through many variations, bursting onto the medical scene with great success, slowly waning for a couple decades and then popping back up again in recent years. The type of benzodiazepine prescribed is largely dependent on a patient’s medical condition. Most start taking effect soon after ingestion, but some, like Klonopin, have longer-lasting effects than others.
The short-term side effects of benzodiazepine use include the following:
- Relaxed feeling
- Mood instability
- Stuttering or slurring of speech
- Poor coordination
- Blurred and/or double vision
- Lapses or loss of short-term memory
The long-term effects of benzodiazepines include:
- Impaired cognition
- Poor judgment
- Memory lapses
- Poor coordination
- Slurred speech
- Muscle fatigue
The following are signs of a benzodiazepine overdose:
- Shallow breathing
- Damp skin
- Dilated pupils
- Weak and/or accelerated pulse
The number of benzodiazepine prescriptions filled each year continues to rise. In 2008, 85 million prescriptions for the 20 most popular benzos were filled.Between 2005 and 2011 nearly 1 million emergency room visits involved benzo use or benzo use in combination with opiates or alcohol. Patients who use benzos have a 20% chance of a more serious outcome in the E.R. and patients who combine the drugs with opiates or alcohol have a 25% to 55% chance of a more serious outcome. Older patients, particularly patients 65 or older, have the highest risk of being hospitalized or dying as a result of using the drugs. Benzodiazepine use has other risks for seniors. One study found a 50% increased risk for the development of dementia in patients over age 65.
Four of every 10 people taking benzodiazepines daily for six weeks or longer face the possibility of addiction.People with mental health problems like mood or personality disorders are more likely to develop an addiction, as are males, 18- to 44-year-olds, single people, Native Americans, and those in lower socioeconomic classes. One study shows 80 percent of benzodiazepines are prescribed for periods no longer than six months but the remaining prescriptions may promote recreational abuse as these patients are more likely to be using many substances.
Benzos and Painkillers
Many prescription painkiller abusers also use benzodiazepines because the drugs boost the effects of opiates. The Substance Abuse and Mental Health Services Administration reports a massive increase of treatment center admissions for patients abusing both benzos and painkillers,going from 5,032 in 2000 to 33,701 in 2010 — a 569.7% escalation. SAMHSA also reports the number of people admitted from 1998 to 2008 for benzo use was nearly a threefold difference despite the fact that overall admission numbers only increased 11% in the 10-year period. Nearly 50% of the patients treated for a combined addiction to both opiate-based painkillers and benzodiazepines meet the criteria for a psychiatric disorder.
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