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Ohio Benzodiazepine Addiction Treatment

Ohio Benzodiazepine Addiction Treatment

Benzodiazepines are some of the most widely prescribed and abused drugs on the market today.​​​3 According to the Office of Diversion Control, the following are the number of prescriptions for benzodiazepines in the United States:

Alprazolam (Xanax)

49.0 Million

Lorazepam (Ativan)

27.6 Million

Clonazepam (Klonopin)

26.9 Million

Diazepam (Valium)

15.o Million

Temazepam (Restoril)

8.5 Million

Doctors widely prescribe benzodiazepines to treat a variety of medical conditions. These include anxiety, alcohol withdrawal, panic disorder, and seizure. Chemically speaking, benzodiazepines get their name because of their seven-member diazepine ring that’s attached to a benzene ring. When one or both of these aspects is modified even slightly, chemists can elicit different benzodiazepine medications.

How Do Benzodiazepines Work?

Benzodiazepines work by targeting the gamma amino butyric acid (GABA)-A receptor.4 GABA is very important in the central nervous system because it can inhibit or slow down the activity of neurons in the body. As a result, when a person takes benzodiazepines, the medication tells the GABA-A receptor to slow down responses in the body. The result is changes in the brain that include relaxation and relief of anxiety.

History of Benzodiazepines

A chemist named Leo Sternbach discovered the benzodiazepine chemical formula in 1955.​​​1 However, he and the company abandoned the project because they hadn’t identified a use for the drug yet. The chemist worked for a company named Hoffman-LaRoche, and the company retained the formula for later potential use. Two years later, one of Sternbach’s co-workers noted the compound left over in the laboratory. The researchers decided to submit the compound for animal testing, thinking that maybe they could publish the research and further the knowledge of other chemists.

However, when the researchers started testing the medication on animals, they observed several beneficial results. These included anticonvulsant, sedative, and muscle relaxing properties. As a result, the company decided to further test and ultimately launch the drug in 1960. The compound was called chlodiazepoxide or Librium.

After releasing Librium, chemists started working on modified formulas for benzodiazepines. This led to the further discovery of the medication diazepam (Valium) in 1963. At that time, benzodiazepines proved an improvement over other sedative-type medications, such as barbiturates. Doctors also considered them less toxic and less likely to cause addiction than barbiturates.

Benzodiazepines became some of the most-prescribed in the late 1970s out of all medications, according to an article in the journal The Consultant Pharmacist. It wasn’t until the 1980s that doctors started to recognize the addictive effects of benzodiazepines.

Why Do Doctors Use Benzodiazepines?

Benzodiazepines vary in terms of the duration of their effectiveness as well as their potency. A doctor may prescribe benzodiazepines for varying reasons.

Anxiety

Benzodiazepines like alprazolam (Xanax) are FDA-approved to treat anxiety and panic disorders.​​​2 While doctors may prescribe other benzodiazepines in the treatment of anxiety, several large-scale clinical trials have shown alprazolam is “superior” to benzodiazepine options such as lorazepam (Ativan) and diazepam (Valium). Doctors may prescribe benzodiazepines to treat anxiety disorders in the interim while waiting on results from selective-serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors.

Doctors may also prescribe benzodiazepines off-label to treat other mental health disorders, such as depression.

Seizure

Doctors prescribe the medications diazepam and clonazepam to reduce the risk of having a seizure.​​​3 These medications depress the central nervous system, which reduces the likelihood of seizure. Other examples of medicines a doctor may prescribe to reduce the risks for seizure include clobazam (Frisium) and clonazepam (Klonopin).

The potential for relieving seizures is the reason why a person should also use caution in immediately stopping benzodiazepines or going “cold turkey.” Because they lower the seizure threshold,there is increased risk of experiencing seizures when stopping the medications.​​​2 As a result, most doctors recommend tapering the dosages of benzodiazepines to reduce their risks.

Insomnia

Doctors prescribe benzodiazepines to reduce the likelihood that a person will experience insomnia. There are a wide variety of benzodiazepines the FDA has approved to treat this condition. These include quazepam (Doral) and estazolam (ProSom). When a person takes these medications, they have a sedative and hypnotic effect that can help a person go to sleep more easily as well as stay asleep. However, doctors usually prescribe benzodiazepines with the intention that a person will only take them on a short-term basis. Doctors typically recommend other lifestyle changes that can also promote sleep and reduce insomnia.

Anesthesia

Anesthesiologists use benzodiazepines as an adjunctive therapy in providing anesthesia. A commonly used, short-acting benzodiazepine is midazolam (Versed). Doctors often give this medication prior to surgery because of its anxiety-relieving effects as well as its ability to affect short-term memory. This can help those who suffer from traumatic stress related to surgery or trauma.

Doctors may also request muscle-relaxing benzodiazepines, such as Valium, as a muscle relaxant. This can help those recovering from surgery, such as chest wall surgery to correct pectus excavatum. In addition, doctors may prescribe benzodiazepines as part of sedation dentistry for those who have a significant fear of going to the dentist.​​​3

Muscle Relaxation

Benzodiazepines like Valium and Xanax have the potential to reduce the incidence of painful muscle spasms. Because they increase the effects and duration of GABA, this effect also helps inhibit muscle spasms.4 As a result, those with painful joint and muscle conditions may take medications to reduce the occurrence of muscle spasms. Examples include those with osteoarthritis and rheumatoid arthritis.

Alcohol Withdrawal

Alcohol is a central nervous system depressant. When a person withdraws from alcohol use, the lack of the central nervous system depressant can lead to excitation. The result can be an increased risk for seizures. Because benzodiazepines reduce the likelihood a person will have a seizure, doctors may prescribe these medications as part of an alcohol withdrawal process. Not all people will have seizures if they withdraw from alcohol – but if a person has gone through severe withdrawals in the past or has a strong history of chronic alcohol abuse, a doctor may prescribe benzodiazepines.

Benzodiazepines Side Effects

Because benzodiazepines are central nervous system inhibitors, their side effects are often related to the slowing of the central nervous system.4 If a person takes these with other central nervous system depressants (such as alcohol), their side effects are more profound. Some of these potential side effects include the following: ​​​

Impaired Cognition

Some people experience drowsiness and severe impaired cognition related to using benzodiazepines. This effect is heightened in the older adults whose liver may not clear benzodiazepines as quickly as they once did.4 An elderly person may become confused if they take benzodiazepines, especially those that are long-acting such as Valium.

A common side effect the elderly experience related to impaired cognition and benzodiazepines is delirium. This condition can cause intense confusion, impaired judgement, and seeing things that aren’t there. The Oschner Journal reports that as many as 78 to 87 percent of elderly patients in the intensive care unit (ICU) setting may experience delirium. The existence of delirium increases the risks for adverse patient reactions, such as increased mortality and longer hospital stays.

Elderly Patients in ICU Experiencing Delirium
87%

Slow Reaction Time and Impaired Judgement

By slowing the central nervous system, a person may not be able to think as clearly when making decisions. Unfortunately, benzodiazepines’ abilities to impair judgment are abused to facilitate date rape and other criminal acts.3

According to an article in the Ochsner Journal, benzodiazepine use can lead to impaired judgment that makes a person dangerous when driving and is associated with doubling a person’s risk for getting in a driving accident. This is true even when one person has a single dose of benzodiazepines, not just when a person struggles with chronic use. 4

Vein Irritation

Benzodiazepines diazepam and lorazepam each contain a chemical that helps preserve the medication in its liquid form for injection. These chemicals can cause venoirritation, which leads to pain on injection. The two benzodiazepines known to cause venoirritation are diazepam and lorazepam.4

Additional potential side effects benzodiazepines cause include:

  • Dizziness
  • Fainting
  • Numbness
  • Vertigo

A doctor should review the potential side effects before prescribing these medications.

Benzodiazepines Withdrawal Symptoms

Pharmaceutical manufacturers didn’t initially intend benzodiazepines to be used long-term.2 There are several key aspects of benzodiazepines that don’t make them well-suited to continued use and abuse. For example, the body is more likely to develop a tolerance to the hypnotic, sedative, and anti-seizure actions of benzodiazepines. These are often the desired clinical endpoints for doctors trying to prescribe them to reduce a person’s seizure risk or help a person sleep. However, the body is less likely to develop tolerance to the memory-affecting and anxiety-relieving effects of taking benzodiazepines.

If a person takes benzodiazepines for longer than a few weeks or takes high doses in a two-week or longer time span, they will likely experience side effects associated with their withdrawals. The side effects are similar no matter what benzodiazepine type a person is withdrawing from.2 The time a person starts to experience withdrawals after their last dose may vary based on the benzodiazepine(s) abused. Also, more potent benzodiazepines, such as alprazolam, may cause more significant symptoms associated with withdrawal.

Insomnia

Difficulty sleeping is often one of the first symptoms associated with benzodiazepine withdrawals, according to an article in the journal Addiction.5 These usually start within one to four days of stopping benzodiazepine use, depending upon how long the benzodiazepine of choice was being used.

Anxiety

Because benzodiazepines are anxiety-relieving medications, stopping the medicines can cause a phenomenon known as “rebound anxiety”.2 When this occurs, a person’s anxiety symptoms may be more severe than before they started taking the medication. According to an article in the Journal of Addiction Medicines, in a study of 126 participants withdrawing from alprazolam (Xanax), an estimated 27 percent reported rebound anxiety with their withdrawal symptoms.

Rebound Anxiety with Withdrawal Symptoms
27%

Seizures

Just as benzodiazepines can prevent seizures, they can also lead to seizures when a person starts to withdraw from them. A person’s seizure threshold is no longer lowered by the benzodiazepine, which can result in increased risks for seizures.

Because seizures can be life-threatening, a doctor will usually recommend a tapering plan to help a person reduce their benzodiazepine dependence as well as the risks that they will have a seizure. A doctor will take into account a person’s history of abuse and what drug they are taking when making a recommendation as to the duration of a tapering plan.

Withdrawal Syndrome

The most acute withdrawal symptoms from benzodiazepines usually occur between 10 and 14 days after a person stops using benzodiazepines (providing they do not use a tapering plan).​​​5 At this time, some of the symptoms they can expect to experience include:

  • Dry Heaving
  • Hand Tremors
  • Heart Palpitations
  • Irritability and Mood Disturbances
  • Muscle Pain
  • Nausea
  • Problems Concentrating
  • Sleep Problems
  • Stiffness
  • Sweating

According to an article in the journal Addiction, doctors typically observe that benzodiazepine withdrawals are more significant when a person is withdrawing from taking high doses of short-acting benzodiazepines, such as Xanax.

Severe Withdrawal Symptoms

Although uncommon, the following are some potential severe withdrawal symptoms from benzodiazepines.

Hallucinations

Although a rare side effect of withdrawal, it’s possible that a person can experience hallucinations and lose touch with reality (known as psychosis) when withdrawing from benzodiazepines. ​​​2

Thoughts of Suicide

According to an article in the Journal of Addiction Medicines, benzodiazepines are the potential cause or contributing cause of an estimated one-third of suicide attempts or intentional overdoses.​​​2 While a person’s benzodiazepine addiction or dependence isn’t necessarily the cause, a significant number of people who commit suicide use benzodiazepines to do so.

Unlike the barbiturates that proceeded benzodiazepines as sedatives, benzodiazepines are rarely deadly unless taken in combination with other substances that slow the central nervous system, such as alcohol or painkillers (opioids).

If a person does take excessive benzodiazepines, doctors can administer a drug called flumazenil (Romazicon). Much like naloxone (Narcan) can reverse opiate overdoses, Romazicon can help reduce the effects of benzodiazepines in the body.

Types of Benzodiazepines

Benzodiazepines vary in duration and effectiveness. The following are some examples of benzodiazepines and why a doctor may prescribe them.

Alprazolam (Xanax)

According to an article in the Journal of Addiction Medicines, Xanax is reported in more emergency department visits related to prescription misuse than the next three most-common benzodiazepines. These include lorazepam, diazepam, and clonazepam.2

There are a few aspects of Xanax’s pharmaceutical profile that make it more susceptible to abuse than other benzodiazepines. The drug is highly potent and the body quickly absorbs it. To compare, one milligram (mg) of Xanax is equivalent to 10 milligrams of diazepam (Valium). The body also eliminates it more quickly, which means a person has to take Xanax more often to achieve the desired effect. Over time, the medication can build up in a person’s system and lead to potential side effects.

According to the U.S. Drug Enforcement Administration, Xanax is one of the top three most-diverted drugs on the illegal drug market.3

Chloridiazepoxide (Librium)

Doctors prescribe Librium to treat anxiety and reduce symptoms associated with alcohol withdrawals. 

Clonazepam (Klonopin)

Clonazepam is the second-oldest benzodiazepine and is of high potency.4 This benzodiazepine that has an intermediate to long effect on the body, lasting anywhere from 17 to 60 hours.2 Doctors associate withdrawals from Clonazepam with fewer withdrawal symptoms than short-acting benzodiazepines, such as Xanax.

Doctors prescribe Klonopin to treat conditions such as panic disorders.4

Clorazepate (Tranxene)

Doctors prescribe Tranxene to treat anxiety, alcohol withdrawal, and some seizure types. The medicine is a long-acting one and should be taken with caution. 

Diazepam (Valium)

Diazepam (Valium) is one of the longer-acting benzodiazepines that are available on the market today.4 Doctors administer Valium in a variety of forms, including oral, intravenous (IV), intramuscular, or gel forms. The medicine has not only anxiety-relieving effects, but also muscle-relaxing ones. 

This medication has what doctors call an “active metabolite.” This means that the body turns Valium into another compound that also has effects on the body. Active metabolites can extend the amount of time the drug stays in the body. 4

Estazolam (Prosom)

Prosom is a benzodiazepine doctors use to treat insomnia. Some people may find that it also relieves anxiety. 

Flunitrazepam (Rohypnol)

The U.S. Drug Enforcement Agency classifies benzodiazepines as a schedule IV drug. This means they have medical use and a low potential for abuse. While flunitrazepam may have a schedule IV classification, those who abuse it are subject to harsher penalties usually associated with dealing schedule I drugs, such as heroin. This is because flunitrazepam is known as a “date rape” drug that can facilitate unwanted sexual contact.​​​3

While the U.S. Food and Drug Administration hasn’t approved flunitrazepam as a legal drug in the United States, it’s important to be aware of this drug and its potential for impairing coordination and slowing reaction time that makes a person more vulnerable for date rape.

Flurazepam (Dalmane)

Doctors prescribe Dalmane to treat mild and moderate insomnia. This medication is a long-acting one. 

Lorazepam (Ativan)

Doctors consider lorazepam (Ativan) a potent benzodiazepine along with clonazepam and alprazolam.4 This means that a small amount of the drug can help a person achieve their desired effect. Doctors prescribe this medication as an anticonvulsant, alcohol withdrawal treatment, and anxiety reliever.

Midazolam (Versed)

Midazolam (Versed) is a medication commonly used in a surgical and medical environment. The drug has a short-term duration of action, and may be given via intravenous drip or injection in a medical setting. Pediatric patients may also receive Versed as a means to reduce post-operative delirium.  

Temazepam (Restoril)

Doctors prescribe Restoril to treat problems falling asleep and other insomnia symptoms. 

Triazolam (Halcion)

Triazolam is a short-acting benzodiazepine that doctors typically prescribe to treat insomnia. 

Finding Help

Benzodiazepines are medications that offer short-term benefits, yet have potential for abuse. Understanding their purpose, potential side effects, and the importance of safe withdrawal are vital to helping a person successfully take the medicines. If a person is concerned they are addicted to or dependent on benzodiazepines, they should talk to their doctor about finding professional help.

Resources

  1. https://www.ncbi.nlm.nih.gov/pubmed/24007886
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4730295/
  3. https://www.deadiversion.usdoj.gov/drug_chem_info/benzo.pdf
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684331/
  5. https://www.ncbi.nlm.nih.gov/pubmed/7841856