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The drug Klonopin (clonazepam) is a member of the class of drugs referred to as benzodiazepines. Benzodiazepines were developed in the 1950s, and Klonopin was one of the benzodiazepines developed in the 1960s by the famous chemist Leo Sternbach. Benzodiazepines remain among the most prescribed drugs in the world and are typically prescribed for the treatment of anxiety disorders. They are also used as anticonvulsants, sedatives, and sleep enhancers, and they can be used in the treatment of withdrawal management issues.

Klonopin’s Mechanism of Action

Benzodiazepines like Klonopin all have their major mechanism of action by facilitating the amount and effectiveness of the primary inhibitory neurotransmitter in the brain, gamma-aminobutyric acid (GABA). Inhibitory neurotransmitters modulate or slow down the firing rates of other neurons in the brain and spinal cord when they are released. This accounts for their medicinal effects.

Benzodiazepines like Klonopin have largely taken over the clinical uses of another similar class of drugs, the barbiturates (also central nervous system depressants) that were commonly used in the treatment of anxiety and for other similar issues that benzodiazepines are now used for. Barbiturates were highly abused and produce significant physical dependence. It was hoped that benzodiazepines would not present a significant potential for abuse and the development of physical dependence; however, benzodiazepines are catalogued as controlled substances by the Drug Enforcement Administration (DEA). Klonopin is designated as a Schedule IV controlled substance, signifying that it has a moderate potential for abuse and physical dependence.

Klonopin is most often used as a tablet or disintegrating wafer, and it is most often prescribed for the treatment of anxiety or seizure control. The drug also has numerous other uses, including to treat restless leg syndrome; to address anxiety and manic issues that occur in bipolar disorder, schizophrenia, and depression; and to assist in the treatment of motor tics in Tourette’s disorder. The drug takes a while to begin working, and it has a half-life that ranges from 10 to 50 hours. This means that it is more suited to treat seizures and issues with anxiety than it is to treat issues like insomnia.

Physical Dependence on Klonopin

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The development of physical dependence on any drug is the body’s reaction to a foreign substance being introduced in the system for a significant period of time. The body attempts to maintain a state of balance or homeostasis in its functioning that includes maintaining significant and appropriate levels of hormones, neurotransmitters, and other substances in the body that help it to run efficiently. When an individual begins to use any medication, the body’s natural set point is disrupted, and the body readjusts to account for the presence of the substance.

For instance, an individual with an anxiety disorder may have a sort of natural level of homeostasis in their body that is conducive to producing issues with anxiety and other problematic behaviors for them. Taking Klonopin increases the availability of GABA in the system and reduces anxiety. This increased GABA is not natural for them, and their body then adjusts itself to account for the increased functioning of GABA in the system. Because GABA is an inhibitory neurotransmitter, the body’s natural attempt to maintain balance is to increase substances that are most likely going to produce the opposite effects that the increase in GABA results in. This means that neurotransmitters that are more excitatory in nature and hormones that produce more excitatory effects will slightly increase to account for the increased GABA in the system. The person then needs to take more Klonopin to get the effects that they got when they initially started taking the drug (tolerance). Over time, tolerance will continue to increase, and the cycle of the body attempting to maintain homeostasis will continue.

Individuals who abuse drugs typically take far higher doses of the drug, take it at more frequent intervals, and may combine it with other drugs.

When the individual stops taking Klonopin or levels of the drug begin to decrease significantly, they will begin to experience the effects of the body’s attempt to maintain homeostasis. The higher levels of other substances that have been increased to account for GABA in the body will be felt, and the individual may begin to experience anxiety, nausea, mood swings, etc. (a withdrawal syndrome). Thus, when an individual has developed both tolerance and withdrawal syndromes, they have become physically dependent, such that they function normally when there is a significant amount of the drug in their system. When the drug becomes depleted in their system, they experience withdrawal symptoms.

When individuals are taking medications for medicinal reasons and under the supervision of a physician, physical dependence is not typically a concern because the physician can control the amounts of the drug the person takes. The withdrawal syndrome is typically not an issue, and the doses that individuals take for medicinal purposes are far lower than the doses that abusers use.

Benzodiazepines like Klonopin are typically not primary drugs of abuse, but they are often abused in conjunction with other drugs, such as alcohol, other benzodiazepines, and opiate medications (prescription pain medications, such as Vicodin and OxyContin). This can be a very dangerous situation. In addition, the withdrawal syndrome from benzodiazepines can be dangerous due to the development of seizures during withdrawal, which can be potentially fatal.

Benzodiazepines like Klonopin are typically not primary drugs of abuse, but they are often abused in conjunction with other drugs, such as alcohol, other benzodiazepines, and opiate medications (prescription pain medications, such as Vicodin and OxyContin). This can be a very dangerous situation. In addition, the withdrawal syndrome from benzodiazepines can be dangerous due to the development of seizures during withdrawal, which can be potentially fatal.

Withdrawal Timeline

Clinical sources and research studies indicate that the withdrawal timeline from Klonopin includes:

  • An acute phase: Depending on the level of tolerance an individual has developed, the acute phase of withdrawal can occur within 24 hours of discontinuation, but it is more likely to occur within 2-4 days after the person stops using the drug. The acute phase of withdrawal from Klonopin may last between five days and one month, depending on the individual’s level of tolerance and other drugs of abuse. Acute phase symptoms include:
    1. Anxiety (rebound anxiety), increased heart rate, increased blood pressure, insomnia, and mood swings
    2. Nausea, vomiting, stomach cramps, and an inability to eat
    3. Confusion, headache, tremors in the hands, and potential seizures
    4. Hallucinations, delusions, and/or significant cravings
  • A protracted phase: The acute symptoms will typically last a week to two weeks in most people, but as stated above, they can last longer. Symptoms then begin to subside slowly. In the protracted phase of withdrawal, individuals most often experience cravings, anxiety, depression, headache, nausea, mild insomnia, and general feelings of malaise for an additional 10-14 days. The intensity and frequency of the symptoms progressively decreases over this period. Seizures are still a potential issue.
  • Chronic issues: Many sources still refer to a syndrome that is most often termed post-acute withdrawal syndrome. This is meant to represent a very long-lasting and chronic phase of withdrawal that occurs after the drug has been eliminated from an individual’s system. Symptoms are mostly psychological in nature and include depression, mood swings, lack of motivation, increased sensitivity to stress, cravings, and increased susceptibility to relapse. However, these symptoms occurring after a drug has been virtually metabolized and eliminated from a person’s system have never been demonstrated by research studies to be actual withdrawal symptoms (symptoms associated with the body’s physical adjustment to declining levels of the drug), but may represent more longstanding psychiatric/psychological issues. This syndrome is not formally recognized as part of the withdrawal process.

The actual experience of withdrawal will be variable depending on how often the person abuse the drug, the amount they typically abused, the overall length of time they have been abusing the drug, individual metabolism, emotional factors, how they discontinue using Klonopin (if they suddenly stop or slowly reduce the amount they take), and if they abused Klonopin in conjunction with other drugs. Nonetheless, withdrawal from any benzodiazepine can be potentially serious due to the development of seizures that can produce significant brain damage. Seizures associated with withdrawal from Klonopin can be potentially fatal due to the potential to produce significant brain damage and other disruptions in the person’s functioning that can lead to serious physical effects and eventually even death.

Medical Detox

When a person is formally treated for physical dependence, the term that is used by organizations such as the American Society of Addiction Medicine, the World Health Organization, and others is withdrawal management. Many treatment facilities refer to the process as medical detox. The withdrawal management process associated with benzodiazepines like Klonopin utilizes:

  • A tapering strategy: Addiction medicine physicians will most often use a longer-acting benzodiazepine in the treatment of withdrawal symptoms for benzodiazepines. They will start with a dosage that results in the person not experiencing any withdrawal symptoms at all; then, at specified intervals, they decrease the dosage by small amounts (taper it down) to allow the individual to adjust to decreasingly smaller amounts of the drug.
  • Extended time: A physician-assisted withdrawal management program will typically proceed on a slow basis and often lasts longer than the withdrawal process might last in an individual not using a tapering strategy. However, it will be less disruptive to the person’s functioning, and it certainly will be much safer.
  • Additional medical management: In some cases, individuals may experience symptoms that require additional medicines such as sleep aids. These individuals will be treated accordingly.
  • Treatment of any associated co-occurring conditions: Individuals with a sedative, hypnotic, or anxiolytic use disorder (the clinical term for an individual with a substance use disorder as a result of Klonopin abuse) often have co-occurring conditions that also need to be addressed. This can include anxiety disorders, depression, some other substance use disorder, etc. These should be treated along with withdrawal from and abuse of Klonopin.
  • Preparation for recovery: Individuals need to participate in comprehensive addiction treatment following detox.

Withdrawal management is only the initial stage of recovery for any individual with any type of substance use disorder. Simply going through the withdrawal management process is not a “cure” for an addictive behavior. Those who do not become involved in an aftercare program, a program of recovery that begins after the withdrawal management process is complete, relapse at rates that approach 100 percent.

Relapse is an issue for individuals who are in treatment for substance use disorders as well. Aftercare programs help individuals to develop relapse prevention programs, deal with stress management, understand the forces that drove their substance abuse, and help them to recover from setbacks, including relapses to drugs or alcohol. Long-term recovery requires years of participation in treatment-related activities and the ability to maintain continued abstinence from drugs and alcohol.