Benzodiazepine

Benzodiazepines are a commonly prescribed medication for sedation. Also called ‘tranquilizers’, benzodiazepines come in a wide range of varieties – amounting to 2,000 different kinds. But presently, the FDA only recognizes 15 which are categorized based on the longevity of their effects.

Presently, benzos are considered a Schedule IV drug which means they have a low potential for abuse and low risk of dependence. But the widespread availability of benzodiazepines and the role they play in countless overdose cases means that abuse might be far more common and likely than it seems.

Benzodiazepines are relatively new drugs, only having been introduced in the1950s. After fine tuning the formulation and modifying its molecular activity, the drug was soon introduced into the market in 1963 as Valium. It only took a little over a decade for benzodiazepines to become the most prescribed medication across the United States.

Typically used for conditions like anxiety, stress, and insomnia, benzos became a common necessity for majority of US citizens because of the commonality of such conditions. But by the 1980s, it became apparent that benzodiazepines weren’t all as harmless as they seemed.

However, while the incidence of abuse was on the rise, medical professionals and organizations continue to prescribe the medication for the lack of an alternative. Instead, the FDA has mandated the display of black box warning labels on the packaging of all approved benzodiazepines.

Interestingly, 23% of people who died of opioid abuse in 2015 were found to also use benzodiazepines. These findings support the long-standing theory that these drugs can result to lethal outcomes when used together. So today, doctors are told to refrain from prescribing the drugs simultaneously.

Presently, it’s believed that while benzo abuse isn’t quite as talked about as other addictions, experts believe that the abuse of the drug has reached epidemic levels. And because these drugs are so commonly prescribed for conditions that are far too frequent, it’s safe to assume that benzo abuse might remain on the rise.

• Misuse of benzos accounts fo 17% of all abuse aross the country
• Benzodiazepine prescription refills increased 67% between 1996 and 2013
• Overdose death rates are 10 times higher in people receiving prescriptions for both opioids and benzos as opposed to those using opioids alone
• A study of overdose deaths in Canada revealed that 60% of those using opioids for non-Cancer pain also used benzos
• Benzodiazepine treatment admissions are most commonly Caucasians, accounting for 85%
• Males account for 56% of all benzo treatment admissions
• 95% of people seeking treatment for benzo abuse are poly-substance abusers
• In 82% of treatment admissions for benzodiazepine abuse, benzos are the secondary substance of abuse, typically used together with opioids, alcohol, or marijuana
• In 2017, benzodiazepine was a culprit in the death of 11,000 deaths in the United States

Used for their effects on anxiety among other problems, benzodiazepines are a group of prescription tranquilizers that are also referred to as anxiolytics (or anti-anxiety medications) or sedatives. Benzodiazepines are categorized based on how quickly they take effect. This divides the drug class into four groups:

• Ultra-short acting
• Short acting
• Long acting

Some of the most commonly prescribed benzodiazepines include Valium, Xanax, and Ativan. Ultra-short acting benzos will manifest their effects for a several minutes, while long acting varieties may stick around for hours. In effect, the withdrawal symptoms from ultra-short acting benzos can also be particularly short while long acting options will only manifest withdrawal symptoms after about one to two days.

Used to sedate and tranquilize the system, benzodiazepines work directly on the central nervous system to relax muscles and reduce anxiety and stress. Some of the short-term effects of benzos include:

• Slowed breathing
• Relaxed mood
• Sense of well-being
• Calmness
• Reduced heart rate
• Feelings of euphoria
• Impaired thinking or decision making
• Drowsiness and sleepiness
• Dry mouth
• Slurred speech
• Blurred vision
• Fatigue
• Heightened risk of accidents
• Ataxia
• Sexual dysfunction
• Dementia
• Permanent cognitive defects

Because of the immediate effects of benzos, they have often been utilized as date rape drugs. As the chemistry of the sedative takes over, victims are less likely to have the strength or the clarity to fight back against a rapist. For those with a prescription, benzos provide relief against a variety of stressors and discomforts.

While it’s not likely to develop a dependence simply by using the drug – especially when taken in doses prescribed by a doctor – there are certain people who are more prone to abuse as they seek the benefits of the medication to combat their daily struggles. That said, individuals who meet specific criteria are more likely to intentionally abuse benzos.

These include people in lower socioeconomic classes, the unemployed, and those with poor family dynamics and unhealthy intimate relationships are just some of the individuals who might be more likely to misuse the drug in order to escape their unpleasant reality.

With time, the constant use of benzodiazepine is likely to result to various effects that might make everyday life difficult. These include:

• Dizziness and headaches
• Nausea and vomiting
• Loss of memory
• Confusion and inability to think clearly
• Fatigue
• Sleep disturbances and insomnia
• Personality changes
• Irritability
• Paranoia
• Aggression and violence
• Skin rashes
• Weight gain
• Lethargy and lack of energy

During the first few uses, individuals might continue to take doses intentionally – which means that they choose to use the drug as opposed to their use being fueled by dependence and addiction. However, over time, users develop dependence which means their bodies get so used to the presence of the drug that they can no longer function without it.

In the absence of benzodiazepine, users feel weak, isolated, moody, and basically unwell which are the characteristics of withdrawal syndrome. This then leads them to take recurring doses so as to avoid the symptoms of withdrawal. According to studies, benzodiazepine can become addictive even at low doses, with 23% of users developing a dependence within 3 months after they begin using the drug.

Other than that, users are also likely to develop a tolerance to benzodiazepine. This means that with the constant use, their bodies become accustomed to the dosage and thus no longer react as noticeably to the drug’s effects. The result is that they need to take higher doses in order to experience their desired potency.

Benzodiazepines work directly with the central nervous system, interfering with GABA functions in the brain. GABA or gamma amino butyric acid is one of the primary inhibitory neurotransmitters in the brain and spinal cord. It contributes to various functions including motor control, vision, and it also help regulate anxiety.

What benzos do is they bind to GABA receptors in the nervous system. Once linked, they encourage these receptors to stay open longer when GABA is released. As the influx of GABA overwhelms the receptors, it’s satiated with Cl-ions which hyper-polarizes the neurons. This then makes it far less excitable to stimulation which results to the effects of benzodiazepines

The first step in treating benzodiazepine abuse is first determining whether a dependence or addiction exists. If the user has just taken a dose, then they might show some of the following signs:

• Slurred speech
• Dizziness and confusion
• Sleepiness and drowsiness
• Impaired physical coordination
• Vomiting, nausea, and stomach pain
• Shallow breathing

If the patient is coming down from the high, they may manifest any of the following signs:

• Anxiety
• Blurred or double vision
• Forgetfulness
• Personality and mood changes
• Irritability and aggression
• Fatigue

In case a patient is rushed to the emergency room for acute benzodiazepine toxicity, it becomes the primary objective to wash away the drug from the system. Doctors have three options, depending on the strength of the dose and the kind of drug used:

• Stomach pumping – A tube is placed directly into the stomach through the mouth or the nose and water is pumped in and suctioned out to cleanse away fragments of the drug. This is rarely ever performed due to the tedious process, the risks, and the higher efficacy rate of other methods.
• Charcoal – A single dose of charcoal is provided to prevent the drug from being absorbed into the system. The charcoal powder is mixed with water which is then administered as a drink. The patient may feel some gastrointestinal discomfort as the charcoal takes effect. This is the most common choice for acute toxicity.
• Flumazenil – This drug reverses the effects of benzodiazepine, but it is rarely ever used. The medicine itself has been known to cause withdrawal symptoms and lethal seizures in patients with a history of chronic benzo abuse.

Much like other drugs, benzodiazepine is removed from the system by reducing the dosage over time. This ‘warm turkey’ detox method helps manage the symptoms of withdrawal and prevents discomfort and pain during the detox process. Behavioral therapies also come into play to help individuals identify the reasons why they abused the drug in the first place.

For eligible individuals, some support and therapy centers can help with housing and employment acquisition. It’s also important to focus on the support systems that individuals have in terms of their families, friends, and intimate relationships. Providing all of these practical tools and techniques can help individuals identify the reasons for their abuse and the possible solutions they can use to prevent future misuse, dependence, and addiction.

It has been reported that up to 60% of those who successfully complete benzodiazepine treatment will relapse within the first year. But that doesn’t mean that treatment has failed. The effects of the drug on the brain make cravings and addiction difficult to overcome, so minor stressors and anxiety can make a person want to experience relief through the drug.

The only course of action in the case of relapse would to simply bring the person back to treatment. Frequent check-ups and follow-ups with the patient and his or her family once they’re discharged from treatment can also help identify potential risks and prevent relapse before it happens.

Benzodiazepine is a silent but deadly drug that’s often used in combination with a range of other substances to produce its effects. Considered an accomplice in thousands of drug-induced deaths, benzodiazepine dependence and addiction is a serious health problem that poses a threat to an individual’s quality of life. Fortunately, the condition is treatable and there are countless rehabilitation programs that aim to help wean abusers from the drug for a healthier, stable life.