In 1996, 8.1 million adult Americans filled a prescription for benzodiazepines.
By 2013, this number had increased by 67% with 13.5 million Americans using benzodiazepines. At the same time, the number of these pills being used also tripled.
How is it possible that overdose at the hands of these drugs has increased by such a factor?
We’ll be exploring this issue today, and we’ll kick off with some basic facts about this class of drug.
While there may be a disturbing number of deaths from benzodiazepine overdose in recent years, it’s the opioid epidemic that’s garnered the most press.
There are more deaths involving opioids than benzodiazepines. Also, 75% of all deaths involving benzos also involve opioids.
That said, the growth of benzodiazepines in the US marketplace, as well as the number of deaths by overdose, is still notable. Medicaid expenditures on benzodiazepines increased by $40 million between 1991 and 2009. The rates of benzodiazepines prescribed alongside opioids also doubled between 2001 and 2013.
By 2016, the FDA had issued a black box warning. This is the most severe warning issued by the Food and Drug Administration and was issued in response to the uptick in co-prescribing opioids and benzos.
More About Benzodiazepines
Benzodiazepines, often shortened to benzos, are a class of sedative drugs used to treat a range of conditions from anxiety and insomnia to seizures.
All benzos are Schedule II-IV drugs according to the DEA.
Benzos induce a similar sedative and calming effect to opioids, but there is significantly less risk of overdose than when using opioids alone.
Rather than working on the opioid receptors as opioid painkillers do, benzos target your GABA receptors. These molecules are mainly concerned with cognitive processes beyond simple life functions. Where abusing opioids could shut down your lungs, for instance, benzodiazepines can trigger problems with amnesia, drowsiness, and motor control if used to excess.
Taking benzos induces a feeling of calmness and relaxation.
When taken at higher doses, the drug can cause drowsiness, a loss of coordination, and vertigo.
The duration of effects depends on the dosage and your tolerance. It could be anywhere from a couple of hours to the whole day.
Benzos are safer than opioids in the sense they won’t suppress your central nervous system, and they shouldn’t stop your breathing either. Both of these are risks you run when abusing opioids.
Although benzodiazepines are used to treat insomnia, nervousness, and restlessness, when this drug is improperly used, it can cause the symptoms it’s intended to treat.
Benzos come in many different varieties. We’ll look next at some of the most common of these.
- Alprazolam (Xanax)
- Chlordiazepoxide (Librium)
- Clonazepam (Klonopin)
- Diazepam (Valium)
- Flunitrazepam (Rohypnol)
- Lorazepam (Ativan)
The effects of these medications are broadly similar even if they are prescribed for slightly different purposes.
Xanax, Klonopin, and Librium are all widely prescribed in the US.
Rohypnol has grabbed the headline as a drug used to sedate victims of date rape.
Where did these drugs come from, then, and why should you care?
Benzodiazepines: A Short History
Benzodiazepines were first developed in 1957 in New Jersey by a chemist working for Swiss pharmaceutical giant, Hoffman La Roche.
Chemists first developed Librium (chlordiazepoxide) accidentally. They were conducting tests for new tranquilizers when they noticed a crystalline residue. They tested this compound and found it had a strong sedative and muscle relaxant properties.
Librium was brought to market in 1960. Valium (diazepam) followed shortly afterward in 1963.
Before benzos hit the market, barbiturates were mostly used for sedation. This class of drugs was developed by German chemists in the early twentieth century. Barbiturates became a very common over-the-counter drug during the Great Depression. At this time, pharmaceutical companies touted barbiturates as a safer alternative to opiates. As we saw years later in the opioid epidemic, these claims amounted to little more than sales pitches.
When America entered WWII in 1941, more than 1 billion barbiturates were being prescribed to Americans every year.
By 1951, Congress intervened and the drug was restricted to prescription-only, drastically reducing the number of users. In reality, this shift in policy did little more than encourage pharmaceutical companies to develop a new generation of sedatives to replace benzos.
Fast forward to the 1980s, and there were 17 benzos available on the market worldwide. The value of the benzodiazepine market was estimated at $3 billion. Up until the 1970s, benzos had been the most prescribed drug on the planet. In Europe, 10% of men and 20% of women have been prescribed benzos at some stage.
Both doctors and patients started becoming more vocal about the obvious potential for abuse of these drugs.
More women than men were prescribed this drug for an assortment of conditions from irritability and insomnia to anxiety. Advertising took advantage of this and aggressively targeted women to capitalize on this gender imbalance.
At this time, advertisers referred to “womanly problems”. The implication was that the generalized anxiety attributed to “nerves” could be amply controlled by a benzodiazepine swallowed daily. The medication was immortalized by the Rolling Stones, Mother’s Little Helper outlining the perceived benefits of Valium for the British housewife.
Even today, more than 61 million benzo prescriptions are written for women compared to 29 million for men. The Anxiety and Depression Association of America confirms that women are more likely to be diagnosed with an anxiety disorder than men. This could be due to a range of factors from brain chemistry to societal stereotypes. It could also be due to the fact women are more likely to experience physical and mental abuse, and that they are also more likely to seek medical help than men.
As more and more benzodiazepines were developed throughout the 1980s, so the problem of dependence and addiction continued growing apace.
In 1979, there was a Senate hearing on the dangers of this class of drugs led by Senator Ted Kennedy.
Nothing came of this hearing, though. Manufacturers bickered and shifted the blame, each claiming that their iteration of the drug was safe. They cited molecular differences and denied all responsibility for a demonstrable problem: this drug is addictive.
Worldwide, prescriptions for benzodiazepines started to drop, but in the US, they continued rising.
The 1990s saw class-action lawsuits against benzodiazepine manufacturers in the UK with plaintiffs alleging that these companies failed to properly warn patients of the health risks and risk of dependence. These lawsuits combined with growing public awareness about the dangers of benzos saw a drop in prescriptions from 32 million to 18 million.
In America, though, the introduction of the Z Drugs (zolpidem, zaleplon, and eszopiclone, branded as Ambien, Sonata, and Lunesta) saw prescriptions rise rather than fall over the 2000s.
From 1996 to 2012, the number of adults with benzodiazepine prescriptions in the US rose from 4.1% of the population to 5.6%. The rate of overdoses more than tripled during the same period, before plateauing in 2010.
What happens if you have been using benzodiazepines for a long time and suddenly discontinue use?
Benzodiazepine Withdrawal Symptoms
Like with most drugs, using benzodiazepines long-term results in physical dependence. This means the body struggles to function in the absence of the drug.
Often, withdrawal symptoms occur if you stop using benzos. Withdrawal is linked to seizures, and there’s also the risk of death. There are also many other side effects that can be unpleasant enough to cause relapse.
Benzodiazepines work in the same way as barbiturates and alcohol by working on the GABA receptors in your brain. This can dramatically increase the risk of seizures when withdrawing from benzos.
Common withdrawal symptoms include:
- Heart palpitations
- High blood pressure
- Muscle pain
- Poor concentration
- Sensory distortion
Withdrawal symptoms can least from days to a whole week depending on the extent of the addiction.
Some acute symptoms like insomnia, fogginess, and depression can linger for months.
In the most severe cases of benzodiazepine withdrawal, seizures and psychosis can occur. This is not a common outcome, though.
The relatively lengthy process of withdrawal is due to the length of time it takes for the endorphins and dopamine levels in your brain to normalize.
What Happens with Benzo Withdrawal?
Benzodiazepines are universally considered one of the worst drugs to withdraw from.
Symptoms are tough to deal with and often last a full week. As mentioned above, the path from this point can remain challenging with adverse side effects manifesting for months after use is discontinued.
The prescription drug monitoring program (PDMP) was a tool set up to help address the abuse of prescriptions and the diversion of drugs. The database tracks and identifies patients who are doctor shopping as well as pinpointing doctors potentially oversubscribing benzos. It’s also possible to track patients being co-prescribed medications. When states require physicians to consult the PDMP, this can help reduce the number of benzodiazepines that end of being misused or abused.
There have been a handful of studies on the effectiveness of the PDMP. It’s shown that this tool has helped to cut the rate of opioid prescriptions by 8% and the rate of overdose deaths by 12%.
OK, now you can see clearly the many problems that occur when benzodiazepines are abused, how can you stop using this prescription drug and kickstart your road to recovery?
Treatment for Addiction to Benzodiazepines
Addiction to drugs or alcohol can be devastating for the individual and also for the whole family. Addiction truly is a family disease.
While benzodiazepines may not attract the stigma of illegal drugs, they can nevertheless exert extreme damage when used or abused.
If you want to kickstart the process of healing, it pays to be fully aware of the dangerous consequences of becoming addicted to benzodiazepines.
At The District Recovery Community, we want to help you build a network of resources to help you break free from the restrictive chains of addiction. The inbuilt irony of benzodiazepines is the way they create the very symptoms they are intended to treat, and this becomes more intense if use strays into long-term misuse and abuse.
If you’re interested in putting the benzodiazepine prescription away and starting the ongoing process of recovery, we’re here to help you achieve that through a personalized treatment program. Call the friendly team today at 844.287.8506 and we’ll get things started right away!