Benzodiazepines, or benzos, are synthetic prescription drugs that have been popular in the United States since the 1960s. Benzo drugs are a type of sedative that acts as a central nervous system depressant to slow down and calm brain activity. They are widely prescribed and highly effective in managing conditions relating to anxiety, insomnia, and even alcohol withdrawal.
However, benzodiazepine prescriptions do not come without risk. Benzodiazepine dependence is a common side effect of benzodiazepine use which can lead to benzo addiction and dangerous benzodiazepine withdrawals.
Benzo prescriptions exploded in the 2000s. And while prescription benzodiazepines have quietly been called the United States’ “other prescription drug problem,” (other than the opioid crisis) prescriptions for benzos were actually starting to decline in 2019.
Unfortunately, after the outbreak of the Coronavirus pandemic, a significant uptick in prescribing benzos for anxiety was again noted. The problem with widespread benzodiazepine use is the risk of either a psychological benzo addiction or physical benzo dependence. In any case, benzos are intended for short-term use. Consequently, when the prescription is no longer available, patients may occasionally seek to refill their prescriptions elsewhere.
This demand for benzos has fueled the black market with fake Xanax and other fake pills that look like various benzodiazepine medications. Unfortunately, these counterfeit Xanax are often laced with dangerous alternatives like fentanyl, a potent opioid that frequently results in overdose. In fact, fake prescriptions in Nevada are of particular concern due to the state’s proximity to Mexico, where many of the counterfeits are manufactured. This occurrence highlights the importance of obtaining prescriptions from only legitimate medical professionals who are legally permitted to dispense the medication.
The benzodiazepine mechanism of action, or the way benzos work, is by enhancing the effects of the neurotransmitter GABA. GABA is a naturally occurring chemical in the brain that produces feelings of calmness. Therefore, it makes sense that when GABA is increased, the result is a relaxed or sedated state.
People often use benzos for sleep or anxiety disorders, since benzodiazepine effects cause a reduction in excitability and agitation. In this light, benzos can also reduce seizure activity and can be used for sedation before surgery.
There are numerous types of benzos available on the prescription drug market. Common benzodiazepines include drugs like Xanax (alprazolam), Valium (diazepam), and Klonopin (clonazepam). Most benzos are taken by mouth in pill form, although liquid, gel, and dissolvable versions are available.
Typically, benzodiazepines are categorized by the amount of time they stay active in the body. The durations generally include short, intermediate, and long-acting.
Benzodiazepine medications are meant to be taken for a short amount of time (ideally, no longer than a few weeks). However, to accommodate chronic conditions, a selection of benzos are available that vary in strength and how long they’re active in the body. Regardless of the type of benzo, any long-term use increases the risk of benzodiazepine addiction.
Short-acting benzos are generally active for three to eight hours. Examples of these include:
Intermediate-acting benzos are generally active for 11-20 hours. Examples of these include:
Long-acting benzos are generally active for 1-3 days. Examples of these include:
Ultimately, the type of benzodiazepine prescribed will depend on the specific condition, symptoms, and personal history of the patient.
Benzodiazepines are a central nervous system depressant, therefore they slow the processes of the body down. However, when taken alone, benzos are unlikely to produce the same life-threatening response that opioids produce. Nonetheless, benzodiazepines are still known to cause some side effects.
The more common adverse effects of benzodiazepines include:
It is important to emphasize that despite the low risk of deadly overdose when taken alone, when benzos are combined with other substances, especially other depressants, the results can be lethal.
The list of benzo drug interactions is lengthy, and it is important that personal nutrition, medications, and recreational alcohol or drug use are disclosed to the prescribing doctor in an effort to avoid benzo drug interactions.
For example, some seemingly harmless over-the-counter medications like antacids are known to interact with benzos by reducing the effectiveness of absorption. Even grapefruit juice can affect the way benzos are processed in the liver, increasing the effects of some benzos and causing unwanted side effects. However, some of the most dangerous benzo drug interactions include benzos and alcohol and benzos and opioids.
Side effects of combining alcohol and benzos include dangerously slowed breathing, unconsciousness, coma, and organ failure.
Given the extreme reactions benzos can create when taken with other substances, benzodiazepines must be taken carefully and with respect to the prescribed dosage.
A few other common risks to benzodiazepine use is benzo tolerance, dependency, and benzodiazepine addiction. Unfortunately, these conditions may arise even when taken as the drug is taken as prescribed.
Benzo tolerance and dependence are common with long-term benzo use. Benzo tolerance, or when the original dose no longer has the desired effect, can develop in as little as two weeks of prescribed use of drugs like Xanax or Valium (or faster if benzos are being misused).
Physical dependency occurs once the body depends on the substance to function normally. Dependency on benzos is not the same as a benzodiazepine addiction, although both may occur at the same time. The reasons for the swift onset of benzo dependence are not clearly understood, but once dependence has developed, benzo withdrawal will occur if the medication is suddenly stopped.
On the other hand, benzo addiction is more of a psychological need to continue taking the drug. While physical dependency may drive the addiction, the two conditions are not exactly the same.
Benzodiazepine addiction is characterized by drug-seeking behavior that continues in spite of the negative consequences that benzo use is causing. For example, if a person has a problem with Xanax abuse, a Xanax addiction would cause the individual to continue Xanax use despite problems with, for example, declining work performance or family responsibilities. Benzo addiction symptoms could also include trying to obtain the drug without a prescription, or by “doctor shopping.”
Behavioral benzo addiction symptoms mirror addiction to any drug and are mainly characterized by abrupt changes in behavior. For example changes in any of the following could indicate a benzodiazepine addiction:
Preoccupation with benzos, benzo cravings, or finishing prescriptions too quickly would also indicate a potential addiction to benzodiazepines. Physical signs of benzo abuse would be similar to the side effects of benzos such as drowsiness, confusion, or lack of coordination.
Overdoses involving benzodiazepine are common if someone has combined the benzo with another substance, or if they are misusing the drug. However, when taken by themselves life-threatening benzo overdose is unusual. The most uncomfortable benzodiazepine side effects are likely to occur with chronic benzodiazepine abuse and benzo withdrawal.
When benzo overdose does occur, benzodiazepine overdose symptoms mirror the side effects of the drug but at a magnified level. While not generally lethal, these reactions can still cause dangerous conditions such as brain damage and respiratory distress.
A few examples of signs of benzo overdose include:
An important exception to the nonlethal properties of most benzo overdoses is if the benzo pill was purchased on the black market. In these cases, a lethal overdose is entirely possible, even if the pill was taken by itself. This is due to a dangerous trend in black market pill manufacturing that includes the use of the synthetic opioid fentanyl as an ingredient, which is often responsible for overdose.
If symptoms of a benzo overdose are noticed, medical authorities should be called immediately. While a benzo antidote (flumazenil) does exist, it is not as widely available as the opioid antidote (naloxone). In addition, the administration of the benzo antidote flumazenil may result in rebound effects when the benzodiazepines are blocked in the body (i.e., seizures).
Alternative benzo overdose treatment is to medically monitor the person while allowing the drugs to wear off. Once a benzodiazepine overdose patient has been stabilized, it is important to address the personal history with benzo use in order to prepare for benzo withdrawals.
Benzodiazepine withdrawal symptoms affect a person both physically and mentally. They occur in the short and long term and will vary in intensity over time. The onset of benzodiazepine withdrawal symptoms will happen sooner with short-acting benzos like Xanax (within 12 hours) and will take longer with longer-acting benzos like Klonopin (within several days).
Acute withdrawal refers to the immediate withdrawal symptoms which are felt as soon as benzo use is stopped. These symptoms are generally short-lived but are more intense than protracted, or long-term benzo withdrawal symptoms.
Acute benzo withdrawal symptoms may include conditions that the drugs were meant to prevent, referred to as a rebound effect. These include:
An estimated benzo withdrawal timeline for short-acting benzos indicates that acute withdrawals will be felt within hours of the last benzo dose. Symptoms will peak about two days later before gradually improving over the next few weeks. Acute symptoms for short-acting benzos should resolve within two weeks to a month.
For long-acting benzos withdrawal symptoms may not be felt for several days to a week, peaking around a week or two later. In these cases, acute benzo withdrawal symptoms may last one to two months.
Some benzo users will go on to experience protracted, or long-term benzo withdrawal symptoms. This is more likely to happen if benzos were misused, used for a long time, or if a dependency developed.
Examples of protracted benzo withdrawal symptoms include:
Protracted withdrawal symptoms are usually less intense than acute withdrawal symptoms but can last for months to years. This can make long-term sobriety challenging if a proper support network has not been established. The ability to manage ongoing withdrawal symptoms is one of the many reasons to consider an accredited addiction treatment facility and the behavioral treatments they provide.
Benzo withdrawal can be dangerous. Ideally, a benzodiazepine taper schedule will be used under the supervision of a medical or addiction treatment facility to gradually reduce the benzo dosage until the medication can be eliminated. By gradually stopping benzodiazepine exposure, many of the withdrawal symptoms can be avoided.
If a cold turkey approach to quitting benzodiazepines must be used, a person is far more likely to experience uncomfortable withdrawal symptoms. These symptoms can last for weeks to months, making long-term sobriety seem like an uphill battle.
Benzodiazepine withdrawal management is just the beginning of treatment for a benzo addiction. In order to address the mental components of drug addiction, an inpatient addiction treatment program is recommended.
During this time, underlying reasons for addictive behaviors can be addressed, including behavioral patterns and social or environmental issues. In addition, coping strategies for life after rehab can be discussed in order to prevent relapse. The ongoing support provided by addiction treatment facilities cannot be understated when treating drug withdrawal symptoms that may last as long as those of benzodiazepines.
The Vance Johnson Recovery Center in Las Vegas Nevada is an accredited addiction treatment facility in Las Vegas, Nevada. The programs at VJRC are evidence-based and holistic in nature, meaning that the individual person and their personal circumstances are taken into consideration when developing a treatment plan for benzo recovery. Additionally, our inpatient residential program provides a comfortable, restorative setting that is supportive of healing and growth.
Listed below are a few of the benzo treatment therapies available at the Vance Johnson Recovery Center:
At VJRC we commit to providing a continuum of care that will address both your mental and physical health needs. This continuum of care is also a commitment to support you throughout your recovery journey before, during, and after treatment at VJRC.
Deciding to commit to benzodiazepine addiction treatment is a huge step towards recovering from addiction. Rest assured that at the Vance Johnson Recovery Center you will be fully supported throughout your transition into recovery. To get started on your recovery, contact one of our admissions specialists at 888-828-2623, or use our confidential online form to ask us anything that comes to mind.