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By THE BALANCE
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Temazepam known by the brand name Restoril is a popular benzodiazepine in the US used for the short-term treatment of insomnia. Insomnia is a sleep disorder in which an individual finds it difficult to sleep or stay asleep. Individuals with insomnia have trouble falling back to sleep after getting awake in the middle of it and are usually tired when they wake up due to poor quality of sleep and inadequate rest. 

Temazepam has been a source of relief to people with insomnia, however, using it as prescribed by the doctor is the key to achieving optimum benefits of the drug and reducing the risk of adverse effects.

Temazepam is the generic name of Restoril- a short-acting benzodiazepine used principally to treat insomnia that is so severe, and disabling that it causes the individual extreme stress. It is the drug of choice for people who do not need excessive sedation for a prolonged period since its action lasts for a short duration. 

Restoril belongs to the class of sedatives and hypnotic drugs. Since Temazepam (Restoril) is a benzodiazepine, it acts as a central nervous system depressant. Temazepam brings about its action by acting on the GABA receptors and stimulating the action of the inhibitory neurotransmitter GABA in the brain and depresses the neuronal excitability by blocking the nerve conduction thereby causing a sedative effect, inducing hypnosis, causing skeletal muscle relaxation, anxiolytic action, and anticonvulsant effect. Therefore, Temazepam is also used to treat panic disorders and severe anxiety apart from insomnia. 

Temazepam is also used as a pre-medication before minor surgical and invasive procedures due to its sedative property. Did you know that before being popular among the civilians, Temazepam was used by the US military as a sedative and hypnotic for the soldiers to achieve proper rest before any operation? It is still used by the US military for the said purpose but its sales in the common population have surged across the years with millions of Temazepam prescriptions dispensed each year. 

However, like other psychoactive drugs, Temazepam too poses a threat for abuse and addiction and hence its use should be strictly monitored. Because of its addiction potential, Temazepam (Restoril) is classified as a Schedule IV controlled substance in the US. It is a prescription-only drug and cannot be attained as an over-the-counter medication. 

Treatment with Temazepam should be under medical supervision and the dose of the drug should be started at the lowest effective dosage to prevent the risk of adverse effects. Moreover, Restoril is used for short-term treatment of insomnia and should not be used for more than 4 weeks since the negative effects of the drugs start showcasing when it is used for a long duration. 

Temazepam is contraindicated in certain conditions and if anyone is found to have any of the problems listed below then they should avoid taking this medication and consult their doctor for a change of medicine. 

Following is the list of indications in which Temazepam is contraindicated:

  • Individuals being hypersensitive to benzodiazepines 
  • Individuals having respiratory difficulties such as pulmonary insufficiency or respiratory depression
  • Individuals dealing with sleep apnea in which a person has respiratory depression during sleep
  • Individuals dealing with chronic psychosis, phobias, or obsession disorders
  • Individuals who have narrow-angle glaucoma 
  • Individuals with severe hepatic insufficiency
  • Individuals with neuromuscular disorders such as myasthenia gravis
  • Individuals who are breast-feeding their child 
  • Individuals with mild anxiety
  • Individuals who are 18 years of age or younger

Temazepam should not be used as the only drug to treat depression and anxiety since it exacerbates the chances of suicide by increasing suicidal thoughts in individuals.

Similar to any other drug, Temazepam has a plethora of side effects that manifest with the use of the drug. However, the presentation of these side effects varies from individual to individual since the metabolism of the drug is different in each person.

Following are the common side effects associated with the use of Temazepam:

  • Headache
  • Dizziness
  • Day time drowsiness as an aftereffect of the drug
  • Tiredness
  • Nausea
  • Nervousness
  • Dry mouth

Following are the serious side effects associated with the use of Temazepam that needs prompt medical help:

  • Confusion
  • Agitation
  • Delusions
  • Hallucinations
  • Anxiety
  • Memory issues 
  • Depressed and low mood
  • Suicidal ideation
  • Difficulty urinating
  • Yellowing of the skin and sclera (white part of the eye)
  • Palpitations (abnormal heartbeat)
  • Poor co-ordination
  • Weak muscles
  • Slurred speech

Temazepam Long-term Use Side Effects

Temazepam is a hypnotic medicine used to treat insomnia for a short duration, and its use should not exceed 4 weeks. In addition, Restoril (Temazepam) should not be used consecutively each day rather it is used every alternate day which makes 3 to 4 doses in a week. However, when individuals start taking Temazepam to treat chronic insomnia and start using the medication for a period longer than prescribed then different side effects come into view.

For a short duration, Restoril will improve the sleep schedule for individuals, however, when taken for a prolonged period, rebound insomnia can present. In this condition, an individual cannot sleep without taking Restoril and if he stops taking Restoril he may suffer from insomnia that is worse than the one for which the medicine was indicated initially. 

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The most feared long-term side effect of Temazepam is the development of dependence on the drug since it paves the way to addiction. Once an addiction to Temazepam develops, it can result in the presentation of withdrawal symptoms upon discontinuation of the drug. 

Effects of Temazepam on the Brain

Temazepam interferes with the activity of GABA neurotransmitters in the brain. GABA is the key inhibitory neurotransmitter in the brain that reduces neuronal excitability throughout the central nervous system and causes sedation and relaxation. GABA blocks the conduction of nerve impulses along the neurons in the brain, thus reducing the brain’s alertness and helps achieve sedation and tranquility, thereby promoting sleep. Since Temazepam is a central nervous system depressant it depresses the respiratory centers in the brain causing labored breathing when taken in excessive doses. 

Yes, Temazepam although amongst the top five most commonly prescribed benzodiazepines in the United States has the potential for an addiction like its other benzodiazepine counterparts. For this reason, Restoril is classified as a Schedule-IV drug in the US which signifies that despite the therapeutic benefits of the drug there is also the risk of abuse and addiction. However, Temazepam is sold in the black market despite the restriction in its sales and is among the top five drugs available on the illicit market. Temazepam is known by many slangs as its street names such as ‘benzos’, ‘downers’, ‘nerve pills’, and ‘tranks’. 

Due to the action of Temazepam to cause sedation, tranquility, and mild euphoria it is often abused and is used for recreational purposes, and addiction to Temazepam is accompanied by unpleasant withdrawal episodes. People abuse Temazepam with other illicit drugs such as cocaine, methamphetamine, alcohol, and opioids to aggravate or intensify the ‘high’ caused by Temazepam. Although Temazepam is a highly effective drug to combat insomnia for the short term, its prolonged use can cause dependence and lead to addiction and even life-threatening overdose. 

Certain factors influence an individual to become addicted to Temazepam because not everybody who abuses Temazepam is addicted to it. According to the American Psychiatric Association (APA), genetic makeup plays one of the primary roles in developing an addiction to drugs such as benzodiazepines. Individuals with a family history of addiction are more prone to being addicted to Temazepam after unsupervised use of the drug. Moreover, environmental and social factors have a significant effect on the development of addiction since peer pressure is one of the most attributable causes promoting addiction amongst teens. Moreover, individuals with mental health issues are more likely to develop an addiction to drugs like Temazepam.

The tranquilizing effect of Temazepam grabs the attention of many individuals who want to seek intoxication who go on to use the drug recreationally. Due to its effect on GABA neurotransmitter which slows the activity of the brain, Temazepam causes sedation and treats insomnia along with creating a euphoric high in the abuser. 

Tolerance to Temazepam develops in as little as three days after which the individual will require greater doses of the drug to achieve the original effect whether for medicinal or recreational purposes. After tolerance, physical dependence develops where the individual finds it hard to do the normal routine task without taking the drug. Soon addiction to Temazepam follows and an individual finds it difficult and struggles to stop taking the drug despite being aware of the negative consequences that result after Temazepam addiction. 

According to National Survey on Drug Use and Health in 2018, 5.4 million Americans, age 12 years and older revealed that they had used prescription benzodiazepine such as Restoril in the past year. Moreover, the America Association of Poison Control Centers reported that in 2016, 74,050 case mentions, 26,868 single exposures, and 14 deaths were associated with benzodiazepines such as Temazepam.

Individuals abuse Temazepam in several ways despite knowing the risk attributed to its misuse. Individuals take someone else’s prescription to satisfy their addiction. Some individuals may take Temazepam for longer than the prescribed duration and in increased doses, this leads to the development of physical dependence which is then followed by addiction to Temazepam. Some individuals go for ‘doctor shopping’ manipulating the doctors into prescribing them Restoril. 

Individuals who abuse Restoril use different methods to abuse the drug to potentiate the effect of the drug such that the drug becomes highly addictive such as by taking large doses of Restoril orally, or by consuming it in the form of a white crystalline powder, or by mixing the powder in a liquid and injecting it into the vein for optimum effect.

Restoril abuse comes with a plethora of signs and symptoms and it is necessary to be aware of these indications so that you can provide treatment to your loved ones if you suspect their involvement in Restoril abuse.

Here is a list of symptoms that can help you spot Restoril (Temazepam) abuse:

  • Using Restoril for a duration longer than prescribed
  • Using someone else’s prescription of Restoril
  • Hiding tablets from friends and family 
  • Using Restoril with other drugs to synergize the effect such as opioids and alcohol
  • Going to multiple doctors to get a Restoril prescription
  • Using illicit means such as stealing, lying, and trading from the black market to get hold of Restoril
  • Feeling unable to function normally without Restoril dose
  • Feeling strong urges to stop Temazepam use but being unsuccessful at attempts to quit taking the drug
  • Experiencing withdrawal symptoms upon discontinuing the drug

Certain physical and psychological signs and symptoms associated with Temazepam (Restoril) abuse are as follows:

  • Anxiety
  • Abdominal cramps
  • Diarrhea
  • Depression
  • Agitation
  • Panic
  • Fear
  • Seizures 
  • Reduced blood pressure
  • Slowed breathing
  • An exaggerated feeling of well-being 
  • Involuntary eye movements
  • Racing and irrational thoughts
  • Fever
  • Increased sweating
  • Increased heart rate- Tachycardia
  • Loss of appetite
  • Tremors
  • Psychosis
  • Hallucinations
  • Muscle spasms and cramps
  • Suicidal thoughts
  • Intense cravings for Temazepam 

Temazepam abuse refers to the inappropriate use of the drug for which it is not medically prescribed. In recommended doses, Temazepam helps a person to attain a peaceful night’s sleep and combats their insomnia. However, when individuals take the drug for a longer duration without the supervision of a medical professional or those who use Temazepam for recreational purposes then dangers associated with Temazepam abuse are likely to happen. 

Tolerance builds rapidly to Temazepam such that an individual will require higher doses of Temazepam to achieve the same therapeutic or recreational effect. Eventually, after taking increased doses of Temazepam, a dependence develops such that the person finds it hard to do the routine task without the administration of the drug. In no time the person becomes addicted to it.

 The greatest danger of Temazepam abuse lies in the mixing of this drug with other central nervous system depressants such as opioids and alcohol as this combination can prove to be life-threatening. Since the action of Restoril, alcohol, and opioids is the same on the central nervous system, the depressive effect is exacerbated with the concomitant use of these substances and causes oversedation, respiratory distress, coma, and death.

When two or more drugs are abused together it is referred to as polysubstance abuse as is the case with the abuse of Temazepam and alcohol or Temazepam and opioids. The risk of death increases by many folds with polysubstance abuse and statistics have shown that between 2002 and 2015 the deaths related to overdose due to the combination of benzodiazepines and opioids have increased by three-folds. 

Treatment for Temazepam addiction is most effective in a residential rehab center or an in-patient rehab facility. In such an atmosphere, the environment will be controlled and supervised by esteemed medical professionals and addiction specialists to provide the affected individuals with round-the-clock care. The primary step in Temazepam Addiction Treatment is detoxification in which the individual’s body will be cleared of all the traces of the drug in a medically assisted detox facility. 

After the completion of detox, rehabilitation follows in which the individual is helped to recover physically and psychologically in a very accommodating environment under the supervision of addiction professionals who keep the individuals occupied and engaged in different activities lestthey not succumb to the cravings of the drug.  Along with individual care and Cognitive Behavioral Therapy (CBT) where the root cause of the addiction is evaluated and the individual is counseled to change underlying thinking patterns, family counseling sessions also take place to teach them how to support the individual during recovery. 

Once rehab is completed, the individual is discharged to home where they can continue the treatment through the Aftercare program which extends for another 12 months after the individual’s discharge and is designed to reduce the relapse rate. Different types of therapies are available and the treatment plan is tailored according to the need of each individual. Following therapies are available as part of the Temazepam addiction treatment plan:

  • Dialectical Behavior Therapy (DBT)
  • Group Counselling
  • Family Counselling
  • Individual Counselling
  • Psychoeducation
  • Yoga and mindfulness
  • Adventure Therapy
  • Life Skills Instruction and Training
  • Alumni Groups

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