What are Benzos?

Benzodiazepine (Benzos) is a family of psychoactive drugs. They operate on the nervous system causing a change in mood, cognition, behavior, or perception. The first drug of this type is said to have been discovered by accident in 1955 and was sold by Hoffmann–La Roche in 1963 as a medication.

Benzos work by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain, inducing sedation, sleepiness, and reducing anxiety. Due to these effects, these drugs have used as a treatment for anxiety, insomnia, agitation, seizures, muscle spasms, Status epilepticus, and Premenstrual syndrome. Benzos are sold under different brand names and come in different types. These drugs are often distinguished by how potent they are and how long they remain effective.

  • Ultra-short acting: Midazolam (Versed), triazolam (Halcion)
  • Short-acting: Alprazolam (Xanax), lorazepam (Ativan)
  • Long-acting: Chlordiazepoxide (Librium), diazepam (Valium)

Benzodiazepines are considered schedule IV controlled substances.

According to the CSA, drugs listed in Schedule IV are classified as such because “Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule III.

In terms of medical use, Benzos are one of the most prescribed medicines in the world. According to IQVIA™, there were 45.0 million alprazolam, 26.4 million lorazepam, 29.2 million clonazepam, 12.6 million diazepams, and 7.0 million temazepam prescriptions dispensed in the U.S.

 

Benzodiazepine drugs abuse

Yet in contrast with its legal status and medical benefits, the drug has shown a high potential for abuse and dependency. The high and the relief that accompanies Benzodiazepines makes the drug subject to recreational use. It is also common as an abused drug due to its popularity. Some people might intentionally abuse it, yet in some cases, a person might take a high dose by mistake. A person who abuses Benzos tries to get prescriptions from several doctors and might even forge ones themselves. Others might steal medicine from other people. In many cases, people obtain their Benzos from illegal sources who smuggle the drugs. In 2017, there were 47,546 alprazolam, 11,430 clonazepam, 4,451 diazepam, 2,315 lorazepam, and 236 temazepam reports from federal, state, and local forensic Laboratories. For 2018, preliminary estimates indicate there were 40,035 alprazolam, 9,900 clonazepam, 3,421 diazepam, 1,901 lorazepam and 204 temazepam reports from Federal, state and local forensic laboratories.

 

What are the effects of Benzos?

Benzodiazepines are seen to be safe as a short-term medication, usually up to 4 weeks, which means that abusing them for longer periods can cause severe side effects. The following are the most common side effects associated with benzodiazepines:

  • Sedation
  • Dizziness
  • Weakness, and
  • Unsteadiness
  • Memory problems

Other side effects may occur:

  • Transient drowsiness commonly experienced during the first few days of treatment
  • Feeling of depression,
  • Loss of orientation
  • Headache
  • Sleep disturbance
  • Confusion
  • Irritability
  • Aggression
  • Excitement
  • Memory impairment

Benzos are believed to have severe effects on cognitive functions such as saving memories. While benzodiazepines may work as a treatment for anxiety, sleep and agitation in some patients, long-term (i.e., greater than 2–4 weeks) use can result in a worsening of the very symptoms the medications are meant to treat.

As mentioned above, Benzodiazepines can cause tolerance and dependence over time. As the brain gets used to the effects of Benzos, the effects it creates become mild. To reach the desired effect the person will increase the dose or take it more frequently. Over time, the increase in dosage will lead to dependence on the drug characterized by a  compulsive need to abuse and withdrawal symptoms when the drug is stopped.

The most frequent symptoms of withdrawal from benzodiazepines are:

  • insomnia, 
  • gastric problems,
  • tremors, agitation,
  • fearfulness,
  • muscle spasms

 The less frequent effects are irritability,

  • Sweating
  • Depersonalization
  • Derealisation
  • Hypersensitivity to stimuli
  • Depression
  • Suicidal behavior
  • Psychosis
  • Seizures
  • Delirium tremens

 

How to do a Benzodiazepine withdrawal and avoid overdose?

For a safe recovery from using Benzodiazepines, medical supervision is advised to help the individual with a gradual reduction of the dosage. Medications can also help in relieving withdrawal physical side effects such as pains and agitation. If you need help with Benzodiazepine addiction, have a look at our website.

In some cases, abusing Benzos can lead to an overdose especially when mixed with other drugs. In a study based on 6,148 cases, there were an estimated 212,770 (95% CI=167,163, 258,377) emergency department visits annually attributed to adverse events involving benzodiazepines. More than half were visits involving nonmedical use of benzodiazepines (119,008; 55.9%, 95% CI=50.0%, 61.9%).

In 2019, 16 percent of overdose deaths involving opioids also involved benzodiazepines. There also reports of self-harm and suicidal tendencies among Benzo abusers. These numbers demonstrate the dangers of Benzos despite their stature. Even when prescribed medically they can still cause complications and lead to dependency. Recent years have seen an increase in illicit use of Benzos as demonstrated by the increased rates of trafficking and smuggling. In the United States, alprazolam is considered to be among the top three prescription medicines that are diverted from the licit market. According to the Drug Enforcement Administration (DEA), there were almost 40,000 alprazolam reports from federal, state, and local forensic laboratories in 2011 and another 18,068 reports between January and June 2012. There have also been several reports of counterfeit medicines or false medicines containing Benzodiazepines. These medicines do not state that they contain these substances in an attempt to trick the customer into buying their product. Recently, in January 2017, the leader of an online pharmacy that illegally distributed tablets containing flubromazolam with the false claim that they contained alprazolam, in addition to illegally distributing various other prescription drugs and narcotic tablets were sentenced to 8 years in prison.

The dangers of medication abuse and addiction are constantly on the rise. People are often burdened by mental and psychological issues and are thus prone to abusing any substances that might relieve their pains. Yet these substances can create bigger health issues and may even lead to death.

 

References

Brunton L, Hilal-Dandan R, Knollmann B, Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 13th ed. McGraw-Hill, New York, NY2018

https://doi.org/10.15585/mmwr.rr6501e1er

Fraser AD (October 1998). “Use and abuse of the benzodiazepines”Therapeutic Drug Monitoring20 (5): 481–9. doi:10.1097/00007691-199810000-00007PMC 2536139PMID 9780123.

Shorter E (2005). “Benzodiazepines”. A Historical Dictionary of Psychiatry. Oxford University Press. pp. 41–2. ISBN 978-0-19-517668-1.

Lader M (2008). “Effectiveness of benzodiazepines: do they work or not?”. Expert Review of Neurotherapeutics (PDF). 8 (8): 1189–91. doi:10.1586/14737175.8.8.1189PMID 18671662S2CID 45155299.

Rapoport MJ, Lanctôt KL, Streiner DL, Bédard M, Vingilis E, Murray B, Schaffer A, Shulman KI, Herrmann N (May 2009). “Benzodiazepine use and driving: a meta-analysis”. The Journal of Clinical Psychiatry70 (5): 663–73. doi:10.4088/JCP.08m04325PMID 19389334.

Longo LP, Johnson B (April 2000). “Addiction: Part I. Benzodiazepines—side effects, abuse risk and alternatives”American Family Physician61 (7): 2121–8. PMID 10779253.