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.[1]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.[2]

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%.[3] 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.[4]

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.[5]Other popular benzodiazepines, Xanax and Halcion, contribute to violent behavior in some people.[6]

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.[7] 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.[8]

Side Effects

The short-term side effects of benzodiazepine use include the following:

  • Drowsiness
  • Relaxed feeling
  • Lethargy
  • Confusion
  • Dizziness
  • Mood instability
  • Stuttering or slurring of speech
  • Poor coordination
  • Blurred and/or double vision
  • Lapses or loss of short-term memory[9]

The long-term effects of benzodiazepines include:

  • Impaired cognition
  • Poor judgment
  • Memory lapses
  • Poor coordination
  • Slurred speech
  • Muscle fatigue[10]

The following are signs of a benzodiazepine overdose:

  • Shallow breathing
  • Damp skin
  • Dilated pupils
  • Weak and/or accelerated pulse
  • Coma10

The number of benzodiazepine prescriptions filled each year continues to rise. In 2008, 85 million prescriptions for the 20 most popular benzos were filled.[11]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.[12] Benzodiazepine use has other risks for seniors. One study found a 50% increased risk for the development of dementia in patients over age 65.[13]

Addiction

Four of every 10 people taking benzodiazepines daily for six weeks or longer face the possibility of addiction.[14]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.[15] 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.[16]

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.[17] 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.[18] Nearly 50% of the patients treated for a combined addiction to both opiate-based painkillers and benzodiazepines meet the criteria for a psychiatric disorder.[19]


[1] U.S. Drug Enforcement Administration. (2015). Benzodiazepines. Drugs of Abuse: A DEA Resource Guide. Retrieved Nov. 28, 2016 from https://www.dea.gov/pr/multimedia-library/publications/drug_of_abuse.pdf.

[2] Longo, Lance P. and Johnson, Brian. (2000). Addiction: Part I. Benzodiazepines—Side Effects, Abuse Risk and Alternatives. American Family Physician. Retrieved Nov. 28, 2016 from http://www.aafp.org/afp/2000/0401/p2121.html.

[3] Cascade, Elisa and Kalali, Amir H. (2008). Use of Benzodiazepines in the Treatment of Anxiety. Psychiatry (Medical Matrix Communications). Retrieved Nov. 28, 2016 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687085/.

[4] Nordqvist, Joseph. (2016). Benzodiazepines: Uses, Side Effects, and Risks. Medical News Today. Retrieved Nov. 28, 2016 from http://www.medicalnewstoday.com/articles/262809.php.

[5] European Monitoring Centre for Drugs and Drug Addiction. (2015). Benzodiazepines drug profile. Retrieved Nov. 28, 2016 from http://www.emcdda.europa.eu/publications/drug-profiles/benzodiazepine.

[6] Parker, Jim. (2009). Benzodiazepine Blues: Living With (and Without) Minor Tranquilizers. Do It Now Foundation. Retrieved Nov. 28, 2016 from http://www.doitnow.org/pages/134.html.

[7] Lane, Christopher. (2010). Brain Damage from Benzodiazepines: The Troubling Facts, Risks, and History of Minor Tranquilizers. Psychology Today. Retrieved Nov. 28, 2016 from https://www.psychologytoday.com/blog/side-effects/201011/brain-damage-benzodiazepines-the-troubling-facts-risks-and-history-minor.

[8] Brennan, Brian. (2008). What Are Benzodiazepines (Such As Valium, Xanax), How Do They Work, And How Are They Used To Treat Anxiety Disorders? ABC News. Retrieved Nov. 28, 2016.

[9] New South Wales Government, Mental Health & Drug & Alcohol Office. (2013). Benzodiazepines. Retrieved Nov. 28, 2016 from http://www.health.nsw.gov.au/mentalhealth/Factsheets/Pages/benzodiazepines.aspx.

[10] University of Maryland, Center for Substance Abuse Research. (2013). Benzodiazepines. Retrieved Nov. 28, 2016 from http://www.cesar.umd.edu/cesar/drugs/benzos.asp#long.

[11]Balestra, Katie. (2009). Critics Cite Serious Side Effects of Benzodiazepine Antidepressants. The Washington Post. Retrieved Nov. 28, 2016 from http://www.washingtonpost.com/wp-dyn/content/article/2009/06/29/AR2009062903105.html.

[12] Substance Abuse and Mental Health Services Administration. (2014). The Dawn Report: Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious ED Visit Outcomes. Retrieved Nov. 28, 2016 from http://www.samhsa.gov/data/sites/default/files/DAWN-SR192-BenzoCombos-2014/DAWN-SR192-BenzoCombos-2014.pdf.

[13] Wood, J. (2015). Benzodiazepines Tied to Higher Risk of Dementia in Elderly. Psych Central. Retrieved Nov. 28, 2016 from http://psychcentral.com/news/2012/09/29/benzodiazepine-xanax-linked-to-increased-risk-of-developing-dementia/45276.html.

[14] Royal College of Psychiatrists Public Education Editorial Board. (2013). Benzodiazepines. Retrieved Nov. 28, 2016 from https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/benzodiazepines.

[15] Dryden-Edwards, Roxanne. (2016). Drug Abuse and Addiction. Medicine Net. Retrieved Nov. 28, 2016 from http://www.medicinenet.com/drug_abuse/page3.htm#what_are_causes_and_risk_factors_for_drug_abuse_and_addiction.

[16] Farnsworth, MG. (1990). Benzodiazepine abuse and dependence: misconceptions and facts. Journal of Family Practice. Retrieved Nov. 28, 2016 from https://www.ncbi.nlm.nih.gov/pubmed/1976739.

[17] SAMHSA. (2012). The TEDS Report. Admissions Reporting Benzodiazepine and Narcotic Pain Reliever Abuse at Treatment Entry. Retrieved Nov. 28, 2016 from https://wwwdasis.samhsa.gov/dasis2/teds_pubs/2010_teds_rpt_natl.pdf.

[18] SAMSHA. (2011). The TEDS Report. Substance Abuse Treatment Admissions for Abuse of Benzodiazepines. Retrieved Nov. 28, 2016 from http://archive.samhsa.gov/data/2k11/WEB_TEDS_028/WEB_TEDS-028_BenzoAdmissions_HTML.pdf

[19] Partnership for Drug-Free Kids. (2012). Treatment Rate Jumps for Addiction to Benzodiazepines and Narcotic Pain Relievers. Retrieved Nov. 28, 2016 from http://www.drugfree.org/news-service/treatment-rate-jumps-for-addiction-to-benzodiazepines-and-narcotic-pain-relievers/.