Benzodiazepines are a class of drugs known as tranquilizers. These drugs act upon the GABA receptors in the brain, the function of those receptors is to reduce the activity of neurons. This will make the nerves less susceptible to stimulation. In this way, benzodiazepines can produce sedation, a calming effect, muscle relaxation, etc. They are used in the treatment of disorders such as anxiety, insomnia, seizures, etc. They are also used in specific settings, such as when a person is going through alcohol withdrawal. These substances are man-made and although pharmaceutical companies have invested thousands of different benzodiazepines, around 15 of them that have been approved by the Food and Drug Administration for commercial use in the United States.
Different Types of Benzodiazepines
Benzodiazepines have three main distinctions: how fast they start taking effect, how long the effects last, and what the specific effects are (what condition they treat). Here is a list of some of the FDA-approved benzodiazepines for commercial use in the United States.
*This table is for informational purposes. You should always consult your physician before taking any new medication.
|NAME OF THE SUBSTANCE||POPULAR BRAND NAMES||FORMS AVAILABLE||ACTING TIME||TREATMENT|
|Alprazolam||Xanax, Xanax XR, Naravam||Tablet, Oral concentrate (liquid)||Short-Acting||Anxiety, Panic|
|Chlordiazepoxide||Librium, Libritabs, Poxi, Mitran||Capsules||Long-Acting||Alcohol withdrawal symptoms, Anxiety|
|Clobazam||Onfi, Sympazan||Tablet, Oral suspension, Oral film||Long-Acting||Seizures|
|Clonazepam||KlonoPIN, KlonoPIN Wafers||Tablet||Long-Acting||Panic, Seizures|
|Clorazepate||Tranxene, Tranxene T-Tab, Tranxene SD, Gen-XENE||Tablet||Long-Acting||Alcohol withdrawal symptoms, Anxiety, Seizures|
|Diazepam||Valium, Diazepam Intensol, Valtoco, Diastat||Injection, Intramuscular injection, Oral solution, Rectal gel, Tablet||Long-Acting||Alcohol withdrawal symptoms, Anxiety, Muscle spasms, Seizures|
|Lorazepam||Ativan||Injection, Oral concentrate, Tablet||Intermediate Acting||Anxiety, Insomnia, Seizures|
|Midazolam||Versed, Seizalam||Injection, Oral syrup||Short-Acting||Anesthesia, Sedation before an operation|
|Oxazepam||Serax||Capsules||Short-Acting||Alcohol withdrawal symptoms, Anxiety|
What Do Benzodiazepines Look Like?
There are numerous different kinds of Benzodiazepines, as shown in the table above, but here are a few examples:
Use of illegal benzodiazepines in the US
The benzodiazepines mentioned above are legal to consume with a prescription. There are however illegal benzodiazepines that are trafficked in the U.S. and used recreationally. One of those is Rohypnol (flunitrazepam), commonly referred to as roofies or date-rape drugs. Rohypnol is a sleeping pill and is legally sold as such in some countries, including many in South America. It is estimated to be close to 10 times stronger than Valium. Using it can create several effects, such as sedation, amnesia, blackout, mental impairment, physical impairment, muscle relaxation, etc. These effects are why it can be used to facilitate sexual assault, as the unsuspecting victim wouldn’t be able to fight back and often wouldn’t clearly remember the events that transpired. People who are abusing other drugs such as heroin, meth, cocaine, etc. will sometimes use Rohypnol to less the withdrawal symptoms that can occur, such as feeling anxious, having trouble sleeping, etc. Because of its potency, Rohypnol is very addictive and will itself have withdrawal symptoms.
Another illegal benzo that is used on a regular basis is phenazepam. It is a very potent, long-acting benzodiazepine first created in the Soviet Union as a treatment for seizures, anxiety, and sleeping problems. Because of its potency, there is a high risk of overdose. Overdoses come about especially when combined with prescription opioids. Using phenazepam can endanger lives and should not be taken lightly.
What are the different names and slang terms associated with benzodiazepines?
Here are some of the street names associated with benzodiazepines in general:
- Chill pills
- Sleeping pills
- Z Bars
There are also specific street names for specific benzodiazepines.
|Upjohn||Super Valium||Yellow V's|
History of Benzodiazepines
Benzodiazepines were first formulated in the 50s. Some were introduced to the market in the 60s. They were deemed much safer with a lower risk of addiction than the meds that came before. Use of those meds exploded during the 60 and the beginning of the 70s. This continued through the 70s, benzos becoming some of the most prescribed medications. With this came the reality of abuse and addiction which people started noticing in the early 80s. Since that time, many more benzos have been developed, but regulations have been put in place to limit abuse and addiction such as shorter prescription periods.
Effects of benzodiazepines
Benzodiazepines present a wide variety of effects and side effects. Here are some of the effects of benzodiazepines. This list may not be exhaustive, make sure to check the side effects associated to a specific benzo before taking any medication.
- Dry mouth
- Impaired coordination
- Increase or decrease in appetite
- Loss of orientation
- Memory impairment
- Muscle weakness
- Numbed emotions
- Reduced awareness
- Reduced libido
- Stomach upset and diarrhea
- Vision problems
- Weight gain
Although benzodiazepines are tranquilizers, some people have been known to experience side effects that are actually the opposite of what the medication is supposed to do, such as:
- Feeling of depression
There are two main ways to overdose: taking too high a dose of benzodiazepine (one should always take the amount prescribed and no more) or mixing benzos with another substance, such as alcohol, barbiturates, opioids, pain medication, and sedatives. Benzos depress the central nervous system, so adding another substance which has a similar effect can lead to respiratory depression, where the person won’t be able to take in enough oxygen for the body to function properly. This can be fatal.
Here are some signs that a person is going into benzodiazepine overdose:
- Altered mental state
- Blue in the fingernails or lips
- Blurred vision
- Difficulty breathing
- Lack of coordination
- Slurred speech
- Uncoordinated movement
Obviously, the signs will vary from person to person depending on the amount of benzo taken, whether or not the person ingested another substance along with it, how long the person has been taking/abusing the medication, etc. When in doubt, seek medical care right away.
According to NewScientist, benzodiazepine deaths have increased elevenfold from 1999 to 2017. A majority of these deaths involved opioids as well as benzodiazepines. This is especially alarming considering that it is estimated that about a third of all benzodiazepine prescriptions are coupled with an opioid prescription.
There are three main ways that people can develop a dependence on benzodiazepines: taking the medication for too long, not following their prescription (taking the med too often or taking too much of it), or actually abusing the drug recreationally.
It is a well-known fact in the medical industry that being on benzodiazepines for too long, even if following a prescription to the letter, will create a physical dependence on the patient. Therefore, prescriptions are usually limited to just a few weeks. If a person goes on longer, they will become physically addicted to it, and that comes with unpleasant withdrawal symptoms. And the easy way to get rid of those withdrawal symptoms is to take some more, and thus begins the cycle of addiction.
Misusing the drug even if on a standard prescription can bring about a similar cycle. One thing to note is that if one starts taking too much of the drug or taking It too often, there are more risks involved, such as overdosing. The body will also develop more of a tolerance for the drug if this is done repeatedly, which can also lead to abuse and addiction. You should always follow your prescription and speak to your healthcare professional if you are uncertain about anything or have any questions.
People who start abusing benzodiazepines recreationally can get hooked on the drug very quickly. There are many reasons why a person starts abusing benzodiazepines, these can range from feeling the need to relax or relieve stress, needing help sleeping to increasing/decreasing the effects of other drugs. When mixed with other drugs, such as painkillers, opioids, etc. benzos can enhance the high a person will feel. It can also be used to alleviate the withdrawal symptoms produced by another drug. Combining benzos with another drug can be deadly.
How long do benzodiazepines stay in your system?
After the last dose, benzodiazepines can stay into your system for as long as weeks or months. However, the average time for them to stay in your system is 2-28 days. It does depend on the amount you take and your physical health. Benzodiazepine is safest if it used on a short-term basis but still there can be some cognitive impairments such as aggression and other paradoxical reactions, which mean the opposite effects of what the medication is supposed to do. Long-term use of benzodiazepine is not only not recommended; it is proven to trap the unsuspecting user by creating a tolerance, which means addiction and physical dependency, and also it has unbelievably harsh withdrawal symptoms upon stopping it. Benzodiazepine is in addition a drug widely abused, commonly sold on the street, and comes along with the same incredibly harsh withdrawal symptoms often resulting in a psychotic break, and sometimes resulting in hospitalization in a psychiatric hospital. Benzodiazepines have many designated street names, and here are some of them: tranks, chill pills, zannies, candy and downers. Always seek professional help to detox from benzos.
Signs of benzodiazepine abuse and addiction
There are signs that one should be aware to detect if a person has developed a dependence on benzodiazepines. Some of the signs are similar to any other drug addiction, such as significant changes in the way they look or the way they act. Addiction, as it goes on, tends to take over the life of the person. So the way they interact with others will change as they become more and more on getting the drugs. There are also specific signs one can observe in a person who ha been abusing benzodiazepine for some time. Anxiety, insomnia, headaches, and feeling weak are some of the symptoms that can appear as one abuses benzos on a regular basis. Getting treatment for benzodiazepine abuse or addiction needs to be a priority at that point.
How to help a loved one addicted to benzodiazepines
Once you have realized that someone you love is addicted to benzodiazepines, it is vital to take action. It can be very overwhelming. However, educating yourself on benzo dependence as well as addiction in general can be very helpful, especially when trying to get them help. The issue needs to be addressed, and it can be treated. It is a thin line between helping a benzodiazepine addict and enabling them. Enabling refers to actions that help the addiction go unaddressed and allows it to continue. An example of enabling would be to give financial assistance to an addict. While it looks like you are helping, you are, in fact, just helping the addict get more drugs. One way to look at it is that you want to support the person but not support the addiction. There are some steps you can take to get them the help they need.
Once you are educated on the subject and understand it, you must bring up the issue. You need to make it clear that you are aware that they have a problem and that you want to help them, but that the behaviors associated with their addiction are not okay. It's important to let them know that you want to help them get treatment. When having this conversation, be mentally prepared for the reaction you might get. When confronted with their behavior and actions, some people can get very defensive and lash out. Others might be in complete denial. It is crucial to stay the course. Setting boundaries and sticking to them is an excellent way to keep from enabling your loved one's behavior. For example, if you let them know that you will no longer give them any money and they want to go grocery shopping or eat at a restaurant, offer to go with them to pay but do not give them money.
If the addict agrees to get treatment, do not waste a second. Get them into treatment as soon as possible. It can be helpful to speak to one of our referral specialists available 24/7. They can assess your needs and help you find the right treatment for your loved one. However, if a person is very resistant to handling their addiction, an intervention should be performed. This can be done with a professional interventionist that is used to the process. An intervention has specific steps to be followed to be successful.
The first step to treat benzodiazepine abuse or addiction will be a medical detox. This can be done in different settings, but medical supervision is key. Stopping the drug abruptly is actually quite dangerous; it can lead to tremors, vomiting, and even seizures.
Here are some of the physical and psychological symptoms that can occur when one is going through benzodiazepine withdrawal:
- Flu-like symptoms
- High blood pressure
- Problems with memory and concentration
- Stomach problems/Vomiting
- Visual problems such as blurred vision
Therefore, being a medical setting where one can be tapered off the drug is key. The specialist will be able to help manage the symptoms and safely get you off the drug.
Once a person is through the withdrawal and is now drug-free, a full rehabilitation program is in order to ensure that the person stays drug-free. Depending on one’s situation, different types of rehabs may work best. If one can, the best thing to do would be to attend long-term inpatient drug treatment. This type of program gives you the time and the tools to handle the underlying issues that lead to substance abuse and help the person handle the problems that were created by the addiction itself. Getting the correct tools to handle life is a key factor in preventing relapse. The person will have to get back to their lives and find ways to deal with day-to-day situations so there is no need to turn to benzodiazepines.
Each treatment program will have different types of therapies available. Speaking to a professional counselor and getting a proper assessment can help one determine which kind of treatment would best suit one’s needs. No matter which setting best suits a person, they should always ask questions about the program features and seek to find out how it will help them get control of their life in the long term. Following treatment, it is always a good idea to look for good aftercare services to help with the transition to normal life and get a good support system to help one stay sober.
Benzodiazepine Use and Abuse Statistics
- Between 2014 and 2016, 62% of all elderly patients who visited a healthcare professional were prescribed a benzodiazepine.
- Across all age groups (18+), 27% of all visits resulted in a benzodiazepine prescription. Most of them were covered by either a private insurance or Medicaid. This equates to about 66 million doctor visits where a benzodiazepine was prescribed.
In an article published in 2017 by The New England Journal of Medicine, it was reported that over a third of all patients that received a new prescription for benzos end up taking the medication for more than 3 months. This is concerning as usage for more than a few weeks is known to create physical tolerance as well as dependence.
In terms of benzodiazepine abuse, it was reported that most of the time, benzodiazepines are not the primary drug of choice, but are used in combination. According to The TEDS Report, when looking at benzodiazepine treatment admissions in 2008, it was found that over 85% started abusing benzos after they were already abusing another substance. The main substances which were used in conjunction with benzodiazepines were opioids (over 50%), alcohol (around 25%), and marijuana (over 10%).
Definitions of common terms related to benzodiazepines
|Benzodiazepine Abuse||any consumption of benzodiazepine other than the dose and interval prescribed by a medical professional.|
|Benzodiazepine Detox||a process of tapering off benzodiazepines in order to manage withdrawal symptoms and safely stop using benzodiazepines.|
|Benzodiazepine Overdose||respiratory depression caused by benzodiazepines (in small or large quantities) or by benzodiazepines interacting with another substance. |
This can lead to coma and death.
|GABA Receptors||proteins found on the surfaces of nerve cells which make the nerves in the brain less sensitive to any kind of stimulation. |
Benzodiazepines attach themselves to these receptors to bring about a calming effect.
|Hypnotic||a drug that induces sleep|
|Tranquilizer||a medication taken to reduce tension or anxiety.|