Klonopin is a branded formulation of clonazepam—a prescription benzodiazepine used primarily in the treatment of panic disorder and seizures.1 Off-label uses include the management of neuralgias, restless leg syndrome, and generalized anxiety disorder.2 Nearly 30 million prescriptions for clonazepam were dispensed in 2017. In addition to being one of the 5 top prescribed benzodiazepines in the country, clonazepam is also one of the most diverted sedatives on the illicit market.3
What Does Klonopin Do?
Like other drugs in the benzodiazepine class, Klonopin is thought to enhance the activity of the inhibitory neurotransmitter GABA (gamma-aminobutyric acid).1 As a central nervous system, or CNS depressant, the resultant slowing of brain activity associated with Klonopin use has several therapeutic applications—such as the management of seizure activity as well as anxiety.4
Though it can be a valuable pharmacotherapeutic, aspects of this same mechanism of action may also lead to a surge in dopamine release that accompanies Klonopin use—especially at high doses.5 This increased dopamine activity is thought to increase the reward associated with certain types of drug use and, in this context, can reinforce continued misuse of Klonopin.
What Are the Side Effects of Klonopin?
Klonopin use and misuse is associated with several potential adverse effects, including:1,4,8
- Poor concentration.
- Problems with memory.
- Impaired cognitive and motor performance (could increase accidental injury risk).
- Paradoxical psychiatric reactions including agitation and irritability.
- Hallucinations and other psychotic features.
- Respiratory depression (slowed breathing).
- Increased likelihood of dependence and withdrawal upon abrupt discontinuation of the drug.
There is a notable risk of suicidal ideation in people using anti-epileptic drugs such as Klonopin.1 Though rare, such an effect can prompt particularly dangerous situations, as benzodiazepines themselves may serve as the agent of harm in a suicide attempt. Per the Substance Abuse and Mental Health Services (SAMHSA), in 2011, an estimated 29.3 percent of emergency department visits for drug-related suicide attempts involved benzodiazepines, and roughly 9.5 percent were attributable to clonazepam.6
Use of CNS depressants like Klonopin may be additionally dangerous in combination with other substances such alcohol as opioids.1 Combinations of benzodiazepines and opioid painkillers or alcohol were associated with a 24-55% increase in the predicted risk of more serious outcomes—including hospitalizations and/or death—compared with benzodiazepines alone, SAMHSA notes.7
Klonopin and Addiction
An addiction to Klonopin—or, in medical terms, a sedative, hypnotic, or anxiolytic use disorder—may be diagnosed by treatment professionals based on several criteria. These include characteristic signs, symptoms, and changes in behavior such as increased time spent obtaining, using, and recovering from Klonopin and continued misuse of the drug despite the negative social, interpersonal, and medical consequences of such use.8
In all, there are 11 criteria that such a diagnosis is based on. Though we won’t detail them all here, one involves the presence of Klonopin withdrawal, as evidenced by tell-tale discontinuation symptoms or the need to continue taking the drug to stave off the arrival of such symptoms. Such a phenomenon commonly occurs in people who have developed significant physiological dependence to a drug, then abruptly quit or cut back on use.
Klonopin Withdrawal and Dependency
Especially in instances of excessive dosing and use over extended periods of time (e.g., several weeks to months or more), there is a risk of physical dependence development. An individual with a significant amount of Klonopin dependence may additionally be at risk of experiencing a potentially severe acute withdrawal syndrome which may include symptoms such as:1,4,8,9
- Racing pulse.
- Abdominal cramps.
- Muscle aches.
Because of the significant health risks associated with acute Klonopin withdrawal, recovery efforts commonly commence with some form of medically supervised detoxification. In such a setting, pharmaceutical intervention can help minimize the likelihood of severe symptoms or complications such as seizures, when necessary.
Medical Detox for Klonopin Withdrawal Management
For many, early recovery from an addiction to Klonopin is likely to involve some withdrawal symptoms; in some cases, apprehension about this often-difficult but necessary hurdle to ongoing recovery delays people from seeking professional help. However, the withdrawal experience can be made considerably less uncomfortable—and much more safe—with medical management.
Especially in instances of long-term and/or high dose use, a gradual withdrawal from Klonopin may be essential to keeping an individual safe and comfortable, which can be achieved either by Klonopin tapering or substitution of other anticonvulsant medication (e.g., other benzodiazepines) prior to completing the tapering schedule over a period of several weeks.1,10,11
Professional medical detox facilitates the support and supervision necessary to initiate a gradual benzodiazepine tapering and other withdrawal management efforts; it also allows for better symptom management and appropriate medical interventions in the event of withdrawal complications.
Counseling, including cognitive and behavioral techniques, can help people as they progress through a sedative taper during withdrawal management. Such techniques can help to alter negative thoughts regarding Klonopin discontinuation as well as help implement non-pharmacologic alternatives to managing any anxiety or insomnia that arise during the process.4,10
In cases of benzodiazepine use disorders, treatment seldom ends with detox alone. There are no medications specifically approved to treat benzodiazepine use disorders, however beyond the period of supervised medical withdrawal management, additional substance rehabilitation—with ample, additional counseling and behavioral therapy—may be hugely beneficial to long-term recovery.4,11
Rehabilitation also facilitates the simultaneous management of any co-occurring mental health issues, such as panic disorder. Integrated treatment approaches for both substance use disorders and mental health issues can help improve treatment outcomes.12
Treatment durations vary based on addiction severity, the rate of recovery progress, the presence of additional medical or mental health issues, as well as other individual needs. The National Institute on Drug Abuse states—in its 13 Principles of Drug Addiction Treatment—that research supports treatment plans of 90 days in length or longer for the best treatment outcomes.12
Another consideration is that of polysubstance addiction. Prescription CNS depressant misuse—such as compulsive Klonopin use—sometimes occurs in a setting of other substance use, such as alcohol or opioids. Such cases of multi-substance use (and a potentially more-complicated polysubstance withdrawal syndrome) will benefit from rehabilitation centers equipped to manage polysubstance use disorders.4
No two people are the same, so no two treatment plans should be identical. Professional treatment teams are aware of this and will implement comprehensive plans for medical detox and rehabilitation based on individual needs.
- S. Department of Health and Human Services—Food & Drug Administration. (2017). Labelling-Medication Guide: Klonopin.
- Hamilton, RJ. (2019). Tarascon Pocket Pharmacopoeia, 2019 Deluxe Lab-Coat Edition. Jones & Bartlett Learning.
- Drug Enforcement Administration—Diversion Control Division. (2019). Benzodiazepines.
- National Institute on Drug Abuse (NIDA). (2018). Prescription CNS Depressants.
- National Institute on Drug Abuse—NIDA Notes Archives. (2012). Well-Known Mechanism Underlies Benzodiazepines’ Addictive Properties.
- S. Department of Health and Human Services—Substance Abuse and Mental Health Services Administration. (2011). Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits.
- S. Department of Health and Human Services—Substance Abuse and Mental Health Services Administration. (2014). The DAWN Report—Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious ED Visit Outcomes.
- Diagnostic and statistical manual of mental disorders: DSM-5(5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
- Nardi AE, et al. (2010). Tapering clonazepam in patients with panic disorder after at least 3 years of treatment. J Clin Psychopharmacol. 2010 Jun; 30(3):290-3.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
- Soyka, M. (2017).Treatment of Benzodiazepine Dependence. New England Journal of Medicine; 2017; 376:1147-1157.
- National Institute of Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).