Benzodiazepines are at the center of a drug epidemic that has largely flown under the radar, writes The Daily Briefing. That’s likely because the ongoing opioid crisis in the U.S. has soaked up much of the nation’s attention and resources to combat the problem.
The apparent rise in benzodiazepine use and related deaths, however, has the attention of observers in the medical community, who warn that prescribing patterns of these drugs need to be addressed ASAP.
A January 2019 study asserts that benzodiazepines (benzos for short) are involved in an increasing number of overdose-related deaths. Researchers also examined benzo prescribing practices and noted that use of the medications has risen because more prescriptions are being written out for them.
A 2016 study supports this claim, as data in that analysis shows that benzo prescriptions have increased considerably in the U.S., as well as overdose mortality involving the drugs. Benzo troubles also play a role in the opioid epidemic. A number of opioid-related overdose deaths involve benzodiazepines and other drugs.
In its report about the increase in benzo prescriptions, National Public Radio wrote that long-term use of the medications has increased. According to data it reported, continuing benzo prescriptions increased by 50 percent between 2005 and 2015.
NPR also highlighted National Institute on Drug Abuse data that showed “a nearly eightfold rise in mortality rates from overdoses involving benzodiazepines — from 0.6 in 100,000 people in 1999 to 4.4 in 2016.”
“That’s somewhere around 10,000 to 12,000 deaths at the hands of benzodiazepines,” Dr. Sumit Agarwal told NPR. Agarwal is an internist, primary care physician and coauthor of the January 2019 study. “This rise is happening quietly, outside of the public eye.”
Benzodiazepines are intended for short-term use despite data showing that more people are using them for far longer than they should. Despite their therapeutic benefits, these are dangerous drugs, and using them can quickly turn fatal. This risk increases considerably when the drugs are misused and abused. While benzos are also abused recreationally, not all benzo misuse is intentional.
An American Psychiatric Association (APA) news release highlights data that says more than 1 in 8 adults in the U.S. used benzodiazepines in the past year and that misuse of the medications accounted for more than 17 percent of overall use, according to a cited study.
The news release goes on to say, “Misuse was highest among young adults 18 to 25 (5.6 percent) and was as common as prescribed use.”
Benzodiazepine dependence can turn into an addiction. Both are causes for concern and require follow-up treatment. Read on to learn more about benzo medications and why they must be handled with care.
Benzodiazepines are potent medications prescribed to treat various conditions, including those involving anxiety and panic, and sleep disturbances, such as insomnia. Medications in this class are also used to treat seizure disorders, muscle spasms, tremors, and the symptoms that occur during severe alcohol or drug withdrawal.
Benzos are known as sedatives or tranquilizers, and they may even be referred to as “downers.” They can be administered as an anesthetic before surgery, or as Harvard Health explains, they can be prescribed to “reduce anticipatory anxiety and the resulting tendency to avoid places and situations that might provoke a panic attack.”
This list is not exhaustive, as it is estimated that roughly 2,000 benzos have been produced. However, only about 15 have been FDA-approved for use in the U.S., according to WebMD. Ativan (generic name lorazepam), Valium (generic name diazepam), and Xanax (alprazolam) are among the most popular ones that are misused and abused.
These medications work by depressing the body’s central nervous system. They boost the functioning of a brain chemical called gamma-Aminobutyric acid (GABA), a chemical of the brain that gives benzos their ability to relax and calm the body. Common side effects of using benzos include:
They also may boost the risk of dementia in people older than age 65, according to Medical News Today.
Benzos fall into three categories: short-acting, intermediate, or long-acting. This is another reason why they are prescribed to treat various ailments.
Prolonged benzo use often leads to physical and psychological dependence or addiction. Addiction can happen to users who have legitimate prescriptions and those who obtained the medication through other means, such as from a loved one’s medicine cabinet or off the street.
Some people even pair the medications with other drugs or alcohol to enhance for stronger effects or to come down off a high from other drugs, such as stimulants. Such use is dangerous and threatening to one’s health and well-being.
Taking the drug frequently or in higher doses usually increases one’s tolerance for it. Once dependence sets in, stopping benzo use is difficult to do.
However, despite the variability of benzodiazepine addiction, there are some signs that are more commonly noted among people who are in active benzodiazepine addiction. Among these common benzodiazepine addiction symptoms are:
Many people who are dependent on benzodiazepines find it challenging to stop using these drugs. Accredited drug and alcohol addiction facilities can offer a path out of benzodiazepine addiction, but users will first have to recognize they have a problem and reach out for help.
People who use benzodiazepines regularly but want to stop are strongly advised to a) avoid quitting the drug abruptly, and b) seek professional detox and addiction treatment to safely manage withdrawal and get off the path to relapse and overdose.
Serious withdrawal from these drugs can include rebound symptoms that made the person take the drug in the first place. These symptoms often return in greater severity that could drive one back into using benzos again just to make the discomfort stop. This, of course, is not recommended. The chance of an overdose is much higher when one goes off a drug for a period before using it again. The body’s tolerance to that drug is much lower than before, making it easy to take more of it than one’s system can handle.
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Detox treatment in the care of health care and mental health care professionals is highly recommended when seeking to stop benzodiazepine use. A monitored withdrawal period ensures clients are kept safe and comfortable and that their needs will be met as they recover.
Effective treatment for benzodiazepine addiction usually starts with medical detox. This three-to seven-day process ensures that all addictive substances and their harmful toxins are removed from the body safely.
With medical and addiction care professionals on board for 24-hour monitoring, medical detox ensures that recovering benzo users will be kept comfortable as they experience withdrawal symptoms that, in some instances, can be life-threatening.
Deadly grand mal seizures, also known as tonic-clonic seizures, are possible, and improperly tapering off the drug can cause delirium and hallucinations, both of which can lead someone to seriously harm themselves, even fatally.
Severe benzo dependency may require that users are gradually and slowly weaned off the drug. This process is known as tapering, and it is done instead of abruptly stopping one’s usual benzo dosage.
Tapering allows the body to slowly adjust to the gradual decrease and exit of benzodiazepines from the body. This process avoids pushing recovering benzo users into immediate, severe withdrawal that could prove fatal.
How long the tapering process lasts may depend on how long the drug has been taken and whether it is short-acting, such as Xanax, or long-acting, such as clonazepam (Klonopin). Consult with a health professional to find the one that is right for you or your loved one. You can read more about tapering here.
Medical detox is just the first step for it alone is not enough to combat addiction. After one has regained physical stability, there’s still a lot of work that has to be done on the mental, emotional and, perhaps, spiritual aspects of recovery. During the detox period, medical professionals and addiction care specialists will make assessments about one’s physical and mental health and determine the proper treatment placement.
In many cases, the input of the person in recovery is considered to ensure the right setting is chosen. If a mental health disorder is detected, a dual diagnosis treatment program may be recommended. This kind of program addresses both the substance use disorder and mental illness at the same time. This is important because it gives the person a chance to recover from both disorders. Treating one without treating the other can lead the person right back into addiction.
Several treatment options can address addiction in all its forms, especially when these options are designed to meet a person’s specific needs.
Residential treatment, also known as inpatient treatment, is the placement that requires a commitment of staying at least 30 days on-site at a 24-hour-monitored facility. This facility offers a structured day and around-the-clock medical support. The National Institute on Drug Abuse recommends at least a 90-day stay in a facility of this kind.
Though treatment program lengths can vary, research indicates that the longer one participates in treatment for three months, the better their chances are of making a successful recovery.
In this setting free of everyday distractions, people can focus on getting well and address their substance abuse behaviors head-on. This includes understanding the compulsive behaviors that led them to addiction.
During this time, a range of therapies is employed to help recovering substance users get on the path to sobriety. These therapies may include cognitive behavioral therapy, family therapy, dialectical behavior therapy, motivational interviewing, among others.
Twelve-step groups, such as Alcoholic Anonymous or Narcotics Anonymous, addiction education, relapse prevention strategies, alumni groups, and much more are available.
People who have completed detox and possibly spent time in a residential facility may find an intensive outpatient program (IOP) suitable for their needs.
This program can provide the aftercare one needs to remain focused on overcoming addiction.
IOP participants have access to the same options people in residential do, but they do not get around-the-clock care at a facility, and they aren’t required to stay on-site at a facility.
They are required to attend nine or more hours of intensive therapy weekly. Therapies can include one-on-one sessions or group sessions.
Those who require the lowest level of care can enter an outpatient program. This is the most flexible option because it allows participants to fit treatment into a schedule that also makes room for their personal and professional obligations.
This setting is ideal for people who are in the mild or very beginning of benzodiazepine addiction as well as those who do not need to undergo a medical detox to get cleared of addictive substances. It is also the least expensive option because it does not require an on-site stay at a treatment facility. Therapy is required for fewer than nine hours a week, and participants can pick up any medications they need during their scheduled visits.
“The Drug Epidemic That's Largely Flown under the Radar.” Advisory Board Daily Briefing. from www.advisory.com/daily-briefing/2019/08/21/benzodiazepines
Agarwal, Sumit D. “Patterns in Outpatient Benzodiazepine Prescribing in the United States.” JAMA Network Open, American Medical Association, 25 Jan. 2019. from jamanetwork.com/journals/jamanetworkopen/fullarticle/2722576
The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) Publications.” American Public Health Association (APHA) Publications. from https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303061
Study Finds Increasing Use, and Misuse, of Benzodiazepines. American Psychiatric Association. from www.psychiatry.org/newsroom/news-releases/study-finds-increasing-use-and-misuse-of-benzodiazepines
Chatterjee, Rhitu. “Steep Climb In Benzodiazepine Prescribing By Primary Care Doctors.” NPR, NPR, 25 Jan. 2019, from www.npr.org/sections/health-shots/2019/01/25/688287824/steep-climb-in-benzodiazepine-prescribing-by-primary-care-doctors
Harvard Health Publishing. (n.d.). Benzodiazepines (and the alternatives). from https://www.health.harvard.edu/mind-and-mood/benzodiazepines_and_the_alternatives
“Benzodiazepine Abuse.” WebMD, WebMD. from www.webmd.com/mental-health/addiction/benzodiazepine-abuse#1
National Institute on Drug Abuse. “How Long Does Drug Addiction Treatment Usually Last?” from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment
National Institute on Drug Abuse. “Overdose Death Rates.” NIDA, January 2019. from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
Nordqvist, Joseph. “Benzodiazepines: Uses, Types, Side Effects, and Risks.” Medical News Today, MediLexicon International, 7 Mar. 2019. from www.medicalnewstoday.com/articles/262809.php