There has been rising attention toward the long-term risks of benzodiazepines, including the potential for addiction, overdose, and cognitive impairment. The
overdose death rate among patients receiving both benzodiazepines and opioids is 10 times higher than those only receiving opioids, and benzo misuse is a serious concern.
What Are Benzodiazepines?
Benzodiazepines are a class of anti-anxiety medications, or anxiolytics, that
increases the activity of the gamma-aminobutyric acid receptors in the brain. GABA is a neurotransmitter, a molecule that helps brain cells, or neurons, communicate with each other. GABA receptors are widely available across the brain, and benzodiazepines work to reduce anxiety by enhancing GABA inhibitory function.
The benzo family includes diazepam or Valium; clonazepam, or Klonopin; lorazepam, or Ativan; chlordiazepoxide, or Librium; and the one most commonly known to the pop culture, alprazolam, or Xanax, among others.
Different benzos have similar effects, but they differ in strength, how long it takes for them to work, and half-life, a measure of how long the drug stays in your system. For example, while
diazepam has a half-life of up to 48 hours, the half-life of
alprazolam can be as short as six hours. This is important, as a shorter half-life is linked with higher potential for addiction and dependence. That is one reason physicians typically aren’t excited about prescribing Xanax for long periods of time.
When Are They Used?
Benzos were introduced to the market in the 1950s and were considered a safer alternative to the
barbiturates then used to treat anxiety. By the 1970s, benzos were among the
most highly prescribed medications.
Benzos are mainly used to treat anxiety disorders, such as phobias, panic disorder, and generalized anxiety disorder. They are mostly used for
a short period at the beginning of the treatment. That is because it may take a few weeks for the main pharmacological treatment for anxiety—antidepressants—to kick in. During that time, if anxiety is severe and debilitating, benzodiazepines may be prescribed for temporary use.
Benzos are also prescribed for occasional situations of high anxiety, such as that caused by phobias. The main treatment of phobias, such as excessive fear of animals, places, and social interactions, is
psychotherapy. Sometimes, however, phobias can interfere with one’s functioning just sporadically, and the person may not be interested in investing in therapy. For example, a person with a fear of flying who may fly on a plane once or twice a year may choose to take a benzo before flying. However, for a businessman or woman who flies several times a month, psychotherapy is recommended.
Benzos may also be used for situations of short-term stress, such as a stressful job interview.
A major risk of long-term use of benzos is
addiction. That means you may become dependent on these meds and must keep increasing the dose to get the same effect. Actually benzos, especially Xanax, have street value because of the pleasant feeling they induce. In 2017, there were more than
11,000 deaths involving benzos alone or with other drugs, and in 2015, a
fifth of those who died of opioid overdose also had benzos in their blood.
Benzos are to anxiety what opioids are to pain. They both are mostly for short-term use, have a potential for addiction, and aren’t a cure. Benzo overdose, especially when mixed with alcohol or opioids, may lead to slowed breathing and potentially death. Benzo misuse can also lead to a lack of restraint of
aggressive or impulsive behavior.
As benzos are sedating medications, they also
increase the risk of accidents and falls, especially in the elderly. This is worse when they are mixed with other central nervous system suppressants like alcohol or opioids.
Stopping benzos abruptly, especially a high dosage, can cause withdrawal symptoms, such as restlessness, irritability, insomnia, muscle tension, blurred vision, and a racing heart. Withdrawal from high doses of benzos, especially those that are shorter-acting, may be dangerous and can lead to seizure. Getting off of these medications should be done under the supervision of a physician.
Safer Options Abound
There are safer effective treatments for anxiety, but they require patience to work. The first-line treatment for anxiety disorders is psychotherapy, mainly
cognitive behavioral therapy. During therapy, the person learns more adaptive coping skills and corrects cognitive distortions to reduce stress.
Exposure therapy is an effective treatment for phobias, social phobia, obsessive-compulsive disorder, and post-traumatic stress disorder. During exposure therapy, the person is gradually exposed to the feared situation under the guidance of the therapist, until the situation doesn’t create anxiety anymore. Importantly, the skills learned during therapy can always be used, allowing a better long-term outcome compared to medications.
Medications are also used for the treatment of anxiety disorders. The main group of such medications is selective serotonin reuptake inhibitors, commonly known as antidepressants. Examples of such medications are fluoxetine, sertraline, and citalopram. Especially when combined with psychotherapy, these medications are effective and are safer options than benzos, and without risk of addiction.