Benzodiazepines — also called benzos — are a class of psychoactive drugs. These drugs are classified as sedative-hypnotics and are commonly prescribed to treat anxiety, insomnia, and other conditions.
While effective in treating such conditions, benzodiazepines are also known for being highly addictive and dangerous to abuse.
The controlled substances alprazolam, clonazepam, diazepam, and lorazepam are all benzodiazepines.
There are many different types of benzodiazepine medications with different formulas and implications. Although most cause the same principal physical effects, absorption time into the bloodstream, dosing standards, and other factors will differ.
To be considered a benzodiazepine, a medication must do one or more of the following:
Benzodiazepines affect an important neurotransmitter in the brain called GABA (gamma-aminobutyric acid). GABA suppresses motor neurons, so neuron activity slows or stops when GABA is present.
Benzodiazepines amplify GABA activity, which results in a slowing of nerve impulses throughout the body. This creates a sedative effect.
Generally, benzodiazepines are classified as either short-acting (cleared from the body relatively quickly) or long-acting (takes much longer to be cleared). How long the benzodiazepine’s effects last will play the largest role in determining which conditions it is used to treat.
Generally, most doctors consider the short-term use of benzodiazepines safe and helpful in treating many disorders.
Some benzodiazepines, for example, are very effective at treating severe alcohol withdrawal. The sedative-like effects of benzodiazepines calm some of the very severe withdrawal symptoms like shaking and extreme anxiety. They can help someone through what is perhaps the most physically challenging aspect of alcohol detox.
In order to prevent abuse, most doctors advise taking benzodiazepines intermittently or for less than one month. Dosing varies by medication.
Most benzodiazepines are prescribed at low or moderate dosage levels. With a low or moderate dose, short-term effects of benzodiazepines may include the following:
Some doctors feel that select patients benefit from long-term use of benzodiazepines for ongoing conditions.
The long-term use of benzodiazepines is problematic for many people because the drug is highly addictive. Effects of long-term benzodiazepine use include the following:
Combining benzodiazepines with some medications, including certain birth control pills and antidepressants, can cause drug buildup and worsen side effects.
Herbs and medications — including St. John’s wort, certain antibiotics, and some anticonvulsants — can lessen the effect of benzodiazepines.
It can be incredibly dangerous and even fatal to use benzodiazepines with certain substances, including alcohol and opioids. One of the effects of benzodiazepines is to slow the heart rate, and this could prove deadly when combined with the depressant effects of opioids or alcohol. This is just one of the reasons that the U.S. Food and Drug Administration released a warning about co-prescribing opioids and benzodiazepines.
In addition to the effects and dangers listed above, there are many other possible dangers of benzodiazepine use.
Benzodiazepines are among the most widely prescribed medications in the U.S.
Benzodiazepines are also commonly prescribed off-label for many conditions, including restless legs syndrome and depression.
Benzodiazepine use has skyrocketed since the late 1990s and continues to grow. According to a 2018 article in the New England Journal of Medicine:
Benzodiazepines offer fast-acting relief of some conditions, like anxiety and withdrawal side effects. This quick-fix effect can become all too tempting for those struggling with these issues. What began as a temporary aid for high-anxiety situations can easily become something needed to get through the day every day.
Users develop a tolerance to benzodiazepines. This most often occurs in people who have used them for six months or more.
There is also cross-tolerance between benzodiazepines and other depressants like barbiturates and alcohol. Using both substances can be dangerous, especially as the symptoms may feel less impactful, and this could result in taking more.
A doctor might increase the dosage of benzodiazepine or prescribe another benzodiazepine to be taken in addition to the already prescribed one when a patient develops a tolerance for the treatment he or she is on.
If someone has developed a tolerance to a benzodiazepine and is unable to obtain a higher dosage prescription from their doctor, they may take a higher dose of their prescription (two pills instead of one), thus running out of their prescription earlier. This can lead to the user trying to obtain more prescriptions from other doctors or trying to obtain more from the black market.
Benzodiazepine withdrawal is serious. Symptoms may include sweating, depression, insomnia, and agitation.
When someone has become dependent on benzodiazepines, quitting cold turkey can be very dangerous. It may result in muscle cramps, tremors, and even life-threatening seizures.
A professional should always be consulted for benzodiazepine withdrawal. They will generally employ a tapering approach to gradually wean the person off the drug.
Benzodiazepines have long been used to effectively treat a number of conditions. They can be used safely and effectively, especially when taken on a short-term basis or intermittently.
Long-term use can easily develop into a serious problem, and it is very dangerous to mix benzodiazepines with other drugs. Someone who is dependent on benzodiazepines should not attempt to detox cold turkey as withdrawal can be life-threatening. Consult a medical professional before stopping use.
(April 2018) Benzodiazepines: America’s ‘Other Prescription Drug Problem’. John Henning Schumann. National Public Radio (NPR). Retrieved February 2019 from https://www.npr.org/sections/health-shots/2018/04/26/602213172/benzodiazepines-america-s-other-prescription-drug-problem
(October 2013) Benzodiazepines. Center for Substance Abuse Research (CESAR). Retrieved February 2019 from http://www.cesar.umd.edu/cesar/drugs/benzos.asp
(January 2018) The Benefits and Risks of Benzodiazepines. Joseph Nordqvist. Medical News Today. Retrieved February 2019 from https://www.medicalnewstoday.com/articles/262809.php
(February 2018) Our Other Prescription Drug Problem. Anna Lembke M.D., Jennifer Papac M.D., Keith Humphreys Ph.D. The New England Journal of Medicine. Retrieved February 2019 from https://www.nejm.org/doi/full/10.1056/NEJMp1715050
(October 2015) What are Benzodiazepines? Lynn Marks. Everyday Health. Retrieved February 2019 from https://www.everydayhealth.com/benzodiazepines/guide/
(August 2016) FDA Requires Strong Warnings for Opioid Analgesics, Prescription Opioid Cough Products, and Benzodiazepine Labeling Related to Serious Risks and Death From Combined Use. U.S. Food and Drug Administration. Retrieved February 2019 from https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm518697.htm