Benzodiazepines make up a class of central nervous system (CNS) depressants that affect a neurotransmitter gamma-aminobutyric acid (GABA). When the neurons in the GABA receptor system fire too frequently, the person can experience anxiety, panic attacks, insomnia, and even seizures. Benzodiazepines have been used for decades to treat anxiety and panic disorder, sleep disturbances related to stress and anxiety, and even some seizure disorders. These medications work very well for short-term use, with a physician’s supervision; however, they are very habit-forming, and the body can become dependent on them very easily. Without appropriate medical supervision, a person can easily become addicted to these medications.
How Are Benzodiazepines Abused?
The Drug Enforcement Administration (DEA) lists benzodiazepines as Schedule IV drugs, meaning they have some potential for abuse, but they also have important medical uses. Benzodiazepines are common in cases of polydrug abuse, as they can enhance the effects of other drugs, especially alcohol and opioids. Sometimes, people struggling with cocaine addiction take benzodiazepines to reduce the anxious and excited effects of cocaine use.
According to the National Survey for Drug Use and Health (NSDUH), in 2011, 20.4 million Americans ages 12 and older reported nonmedical use of benzodiazepines at least once in their lifetime. One of the age groups that abuses benzodiazepines the most are older adults. According to the National Institute of Mental Health (NIMH), just over 5 percent of adults ages 18 and older received at least one benzodiazepine prescription in 2008; however, in looking at the breakdown, 8.4 percent of older adults ages 65-80 received benzodiazepine prescriptions, while 7.4 percent of those 51-64 years old received prescriptions, and 5.4 percent of adults ages 36-50 received prescriptions. Most of these prescriptions were written by physicians, not psychiatrists.
Benzodiazepines may help with short-term conditions like anxiety and sleep disorders, which can become more intense with age, but benzodiazepines have a stronger effect on elderly adults. As a result, they can contribute to long-term problems like dementia. The American Geriatrics Society currently discourages their use in older adults.
While benzodiazepine abuse is a serious concern all over the United States, Texas has some specific concerns around benzodiazepine abuse. For example, an illicit and dangerous combination of alprazolam, hydrocodone, and carisoprodol is called a “Houston cocktail,” or a “holy trinity.” In 2013, alprazolam was the most frequently found benzodiazepine of abuse in Texas forensic labs. Reportedly, 19 percent of poisoning deaths in Texas in 2013 involved benzodiazepines.
Despite their risks, benzodiazepines are still among the most commonly prescribed drugs in the world, especially in the United States.
Most Common Benzodiazepines
There are over 2,000 types of benzodiazepines that have been produced by pharmaceutical companies, but currently, about 15 are approved for use in the United States. Below are the most commonly found benzodiazepines and their uses.
- Xanax: The generic benzodiazepine alprazolam is most commonly found prescribed under the brand name Xanax. This medication a short-acting benzodiazepine used to help people struggling with anxiety disorders, panic attacks, and depression with concurrent anxiety. A newer version of Xanax, called Xanax XR, is an extended-release benzodiazepine designed to work for much of the day.
- Valium: Found also under the generic name diazepam, this is a long-acting benzodiazepine that has been famous for decades. The medication is less frequently prescribed to treat anxiety and panic disorders these days, but because it affects the brain for a long period of time, Valium is often prescribed to treat delirium tremens and seizures associated with alcohol withdrawal. It is also sometimes used as a replacement benzodiazepine when tapering a person off a benzodiazepine dependence.
- Klonopin: This medication’s generic name is clonazepam, and it is a short-acting medication used to treat a variety of conditions, including anxiety, panic attacks, seizures, and some types of epilepsy. For seizure disorders, this medication is prescribed regularly, but when used to treat anxiety conditions, it is typically prescribed “as-needed.”
- Ativan: Also found under the generic name lorazepam, this is a common short-acting, short-term treatment for anxiety disorders, including anxiety associated with depression.
- Rohypnol: Also available under the generic name flunitrazepam, this medication has never been approved for prescription use in the US, but it is legal in Mexico. Rohypnol has been illegal to bring into the US since 1996, even with a prescription, but appears often in Texas as a drug of abuse and a date rape drug.
Other benzodiazepines include Dalmane (flurazepam), Doral (quazepam), Halcion (triazolam), Librium (chlordiazepoxide), ProSom (estazolam), Restoril (temazepam), and Serax (oxazepam).
Benzodiazepine Intoxication and Side Effects
When a person becomes addicted to benzodiazepines, it is typically due to the relaxing euphoria, or high, associated with ingesting large quantities of this medication. Sedatives are generally very habit-forming. Those who take benzodiazepines, whether as prescribed or for nonmedical reasons, can experience various side effects. However, people who struggle with benzodiazepine abuse or addiction are more likely to experience side effects, especially at higher doses.
At high doses, benzodiazepines can produce side effects like:
- Slowed reflexes
- Mood swings or irritability
- Erratic, unpredictable behavior
- Aggression or hostility
The most common withdrawal symptoms associated with benzodiazepines involve rebound effects. Because benzodiazepine drugs reduce the uptake of the GABA neurotransmitter, when that effect stops, the brain begins firing rapidly again. People who stop taking benzodiazepines, either as prescribed or in an attempt to overcome an addiction, typically experience rebound insomnia, anxiety, and panic attacks. Some people may develop a benzodiazepine withdrawal syndrome (BWS), which can include dangerous seizures.
Medical Detox and Complete Rehabilitation
People who struggle with benzodiazepine abuse and addiction, whether the addiction is to benzodiazepines alone or as part of a pattern of polydrug abuse, need professional help. If a person attempts to withdraw from benzodiazepines without medical oversight, they could experience life-threatening withdrawal symptoms. They are also more likely to relapse without social and medical support, and that can also be physically dangerous.
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