Clobazam (also known by the brand names Onfi, Frisium, and Urbanol) is a benzodiazepine drug, approved for the treatment of anxiety, seizures, and Lennox-Gastaut syndrome, a type of epilepsy where individuals experience different types of seizures and often have intellectual impairment. As a benzodiazepine, clobazam is rather long-acting (has a long half-life) and exhibits other features of the benzodiazepine drug class.
Benzodiazepines are central nervous system depressants that increase the levels of gamma-aminobutyric acid (GABA) in the central nervous system. GABA is the major inhibitory neurotransmitter in the brain and spinal cord, and functions to modulate or reduce the activity of the central nervous system. The GABA-enhancing effects of benzodiazepines makes them useful in the treatment of conditions where there is overactivity in the brain and spinal cord, such as seizures, anxiety disorders, issues with insomnia, and muscle tension issues. In addition, some benzodiazepines are used in the treatment of withdrawal from alcohol and other drugs.
Clobazam is categorized as a Schedule IV controlled substance by the United States Drug Enforcement Administration. This indicates that the drug does have practical medicinal uses but also carries the risk for abuse and the development of dependence. Abuse of clobazam is most likely not as common as abuse of other more popular benzodiazepine, such as Xanax, Ativan, Valium, etc.; however, there are numerous reports of its abuse. Even early in its development and marketing, the World Health Organization reported cases of abuse of clobazam.
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Effects of Clobazam Use and Abuse
There are a number of different effects reported by recreational users of clonazepam and other benzodiazepines, per an article published in the journal Addiction.
- Sedation that continues even after tolerance has developed
- Decrease in muscular coordination and the ability to perform tasks
- Difficulty performing complex skills, such as driving
- Impairment of higher brain functions, including learning and memory (particularly learning and memory for new information)
- Paradoxical effects that include increased anxiety and aggression
- Poor overall mental health
- General cognitive decline, including issues with learning and memory
- Issues with performing routine tasks
- Poorer quality sleep in some individuals
- Potential immune system impairments
- The development of physical dependence
Regarding the development of physical dependence on clobazam, a number of studies have indicated that, like with other benzodiazepines, repeated use of clobazam results in the potential to develop both tolerance and withdrawal, even in individuals who use it for medicinal purposes.
Individuals who use benzodiazepines recreationally are more likely to take larger amounts of the drugs and use them in combination with other substances, particularly alcohol. The use of alcohol and clobazam together results in the enhancement of the central nervous system depressant effects and side effects of both substances. The withdrawal syndrome associated with clobazam is similar to the withdrawal syndrome that occurs with other benzodiazepines. It can include issues with nausea, vomiting, rebound anxiety, rebound insomnia, delirium, hallucinations, and the potential to develop seizures, which can be life-threatening.
How to Determine if Someone Is Abusing Clobazam
Because the repeated recreational use of benzodiazepines like clobazam can lead to the development of a substance use disorder, it is important to be able to spot potential signs of abuse as early as possible. According to sources, such as the books Substance Use Disorders: A Practical Guide and Treatment of Substance Use Disorders, individuals abusing drugs like clobazam may display:
- Issues with balance
- Lethargy and drowsiness
- Poor coordination
- Excessive sweating
- Nausea (in some cases, vomiting)
- Slurred speech (the appearance of being intoxicated with alcohol but no smell of alcohol)
- Visual problems
- Slowed or shallow breathing
- Reduced inhibitions
- Poor judgment
- Mood swings
- Issues with memory
- Confusion (more likely in heavy users, people who combine benzodiazepine use with other drugs, and elderly people)
- Dementia-like symptoms (more likely in heavy users and elderly people)
Other signs that may suggest the individual is developing a serious substance use disorder include:
- Getting clobazam illegally
- Doctor shopping by individuals in an attempt to get more prescriptions to benzodiazepines
- Forging prescriptions
- Stealing medications
- Isolating oneself from others
- Giving up activities that were once important
- Finding empty prescription bottles around the house or in an individual’s belongings
- Spending more time with others who are known drug abusers
The American Psychiatric Association lists the formal diagnostic criteria for an anxiolytic use disorder, which is the formal label for a substance use disorder to benzodiazepines. These criteria are designed to be used by mental health professionals in the diagnosis of substance use disorders and include such behaviors as:
- Cravings the drug
- Giving up important activities to use the drug
- Repeatedly using more of the drug than intended
- Negative consequences that are associated with drug use, such as issues at work, issues at school, financial issues, legal issues, or issues in personal relationships
- Failing to meet important obligations as a result of one’s drug use
- Continuing to use the drug in spite of knowing that it is causing issues with health, psychological functioning, or other areas of life
- Repeatedly using the drug in dangerous situations (while driving, drinking alcohol, etc.)
- The development of tolerance
- Withdrawal symptoms when going without the drug
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How to Choose the Right Treatment Program for Clobazam Abuse
Because there is a significant potential for an individual who abuses clobazam to develop physical dependence on the drug and because the withdrawal symptoms from benzodiazepines can have potentially fatal effects, it is extremely important that an individual seeking treatment for clobazam abuse consults with a physician before discontinuing the drug.
Many individuals will want to immediately begin participation in a physician-assisted withdrawal management program. During this process, a physician will monitor the person’s recovery and administer medications, including longer-acting benzodiazepines, to slowly wean the person off the drug of abuse. The benzodiazepine will be administered on a tapering schedule where the physician lowers the dose at subsequent intervals, so the person can slowly wean off the drug with minimal effects. Other medications can be used to control withdrawal symptoms in this process.
Simply undergoing detox from clobazam will not qualify as recovery from a substance use disorder. The person must also become involved in a formal substance use disorder treatment program that includes therapy, social support participation, and psychoeducation. Because many individuals who abuse benzodiazepines also abuse other drugs, such as alcohol, other benzodiazepines, narcotic medications, stimulant medications, etc., it is important that the person be fully assessed to determine the presence of any other substance use disorders and the presence of any co-occurring psychological disorder, such as depression. Co-occurring disorders must be treated at the same time in order for the individual to recover fully.
Treatment for formal substance use disorders is a long-term process. Since there is no cure for addiction, it is a disorder that must be effectively managed for life. This means those in recovery often participate in some form of aftercare, generally on a decreasing basis, for the rest of their lives.