Benzodiazepines are a type of medication in the class of minor tranquilizers. Numerous types of benzodiazepines exist, and many of these are sold under disparate brand names. While effects vary among the different varieties of benzodiazepines on the market, they generally have anxiolytic effects, meaning that they reduce anxiety in people who take them. Many benzodiazepines also have hypnotic effects (inducing sleep), anticonvulsant effects, sedating effects, and also help to relax muscles. As such, benzodiazepines are prescribed for a variety of purposes, ranging from treating anxiety to alleviating the muscle spasms associated with seizures. They are also often effectively used for treating alcohol withdrawal syndrome and insomnia. Given their usefulness for so many different conditions, benzodiazepines are one of the most widely prescribed classes of medications in the United States.
Benzodiazepines, which are formed by fusing the chemical compounds benzene and diazepine, were invented in 1955 and first made available in the 1960s. They work by targeting a neurotransmitter in the brain called gamma-aminobutyric acid (GABA) at the GABAA receptor. The GABA neurotransmitter is chiefly responsible for reducing excitability among neurons in the brain and nervous system. By enhancing the effects of the GABA neurotransmitter, benzodiazepines, along with other drugs like alcohol, provide a sedating effect that can reduce anxiety and calm nerves.
Many varieties of benzodiazepines are sold on the market today, and they are generally categorized based on how quickly effects come on and how long they last. While shorter-acting benzodiazepines are most effective for insomnia and panic attacks, longer-acting benzodiazepines are frequently prescribed for generalized anxiety disorder (GAD). Many patients on benzodiazepines are prescribed multiple varieties of the medication to deal with varying circumstances, such as an individual who takes longer-acting benzodiazepines to deal with generalized anxiety disorder and quick-acting benzodiazepines to deal with occasional panic attacks. The versatility of these medications is part of what makes them such a commonly used remedy.
In recent years, some of the negative effects of benzodiazepines have come to light. Individuals who take the medication for long periods of time often not only find that they become less effective, but many suffer from physical dependence, mental health and memory problems, and severe withdrawal effects. While short term use of benzodiazepines is often perceived as safe and effective, even relatively short term use can, like alcohol, remove behavioral inhibitions and result in dangerous or aggressive behavior. Benzodiazepine use can even result in suicidal ideation, and because of their disinhibitory effects, the likelihood of someone making an attempt on their own life is dramatically increased. Current research suggests that pregnant women and the elderly are at a particular risk for these dangerous side effects. As such, it is important for benzodiazepines to be taken only as directed and under careful medical supervision.
Withdrawal from benzodiazepines is not only difficult, but very dangerous. The process of withdrawing from benzodiazepines can be torturous and traumatic. While opioids may be more famous for their excruciating withdrawal effects, withdrawal from benzodiazepines is actually far more dangerous. Many people suffer from intensified versions of the conditions they were originally prescribed benzodiazepines to treat. Anxiety, cognitive problems, memory issues, nausea, muscle pain, and heart palpitations are some of the most common withdrawal symptoms. Withdrawing from higher doses of benzodiazepines can result in hallucinations, psychosis, increased risk of suicide, convulsions, delirium tremens, and even catatonic comas that can result in death. Unlike other withdrawal timelines that are characterized by gradual reductions in symptoms with each passing day, benzodiazepine withdrawal is notable for occurring in waves; effects dissipate for periods of time, only to re-occur more intensely weeks later. Because of its complicated nature and associated dangers, benzodiazepine withdrawal generally requires medical supervision.
Taking benzodiazepines can result in potentially life-threatening overdoses. Individuals who take high doses of benzodiazepines can enter comas. When the medication is taken alongside other drugs, especially central nervous system depressants like alcohol and opioids, the risk of overdose increases. Respiratory depression is more likely to occur due to the increased dangers surrounding these drug interactions. Taking benzodiazepines along with alcohol tends to increase the effects of the latter, and many users report blacking out after drinking only small amounts of alcohol. Unfortunately, because benzodiazepines reduce inhibitions, it is easy for an individual to impulsively engage in this kind of dangerous drug abuse.
Benzodiazepines were developed in 1955 by an Austrian chemist named Leo Sternbach. Sternbach was working for the pharmaceutical company Hoffmann–La Roche. While trying to develop tranquilizers, Sternbach accidentally synthesized chlordiazepoxide but considered the product a mistake and opted not to test it. Several years later, a co-worker cleaning the lab discovered the abandoned compound and decided to submit it to tests. After animal tests demonstrated chlordiazepoxide’s remarkable sedating, muscle-relaxant, and anticonvulsant effects, the company began selling it in 1960 as Librium. Shortly thereafter, the company began marketing another benzodiazepine, diazepam (Valium). Both Librium and Valium became enormously popular, supplanting barbiturates and other hypnotic and sedative drugs.
For a period of time, benzodiazepines were prescribed very freely. As a result, they were the most popular medications in the United States. However, by the 1980s it was becoming increasingly obvious that benzodiazepine prescriptions came with some notable risks. In fact, the largest class action lawsuit in the United Kingdom came about when over 14,000 patients and 1,800 law firms claimed that pharmaceutical companies deliberately withheld information about the risks of addiction. While the case never reached a verdict, the result was that doctors began informing patients about the dangers associated with benzodiazepine use and even required patients to sign a consent form before receiving a prescription. The days of considering benzodiazepines a miracle drug had come to an end.
Today benzodiazepines are still commonly prescribed, especially for anxiety disorders, though psychiatrists generally aim to prevent patients from relying on the drugs for too long. Their popularity as a treatment for insomnia has waned in favor of a class of drug called nonbenzodiazepines, which are different on a molecular level but behave like traditional benzodiazepines psychodynamically. In the United States, benzodiazepines are classified as a Schedule IV drug, meaning that some potential for abuse and dependence is recognized. Benzodiazepines are in fact widely abused, especially among individuals who already abuse other substances (poly-drug abusers). The ubiquity of benzodiazepine abuse not only leads to countless deaths for year, it has even had an impact on youth culture, with rappers frequently talking about “popping xannnies” (xanax). Given the drugs’ continued importance in medical care and its popularity for recreational use, it looks like for the time being benzodiazepines are here to stay.
Benzodiazepines are drugs that are made in the laboratories of pharmaceutical companies. Countless varieties of benzodiazepines have been synthesized. However, they often go by many different brand names due to the diverse amount of pharmaceutical companies that market them.
While the majority of benzodiazepines on the market are made for medical purposes, it is common for individuals possessing legitimate prescriptions to resell and distribute the medication. Benzodiazepines enjoy enormous popularity on the black market. Many people with physical dependence on benzodiazepines obtain the drug from doctors illegitimately as well. This practice, known as “doctor shopping,” involves switching doctors when they deny benzodiazepine prescriptions and repeatedly visiting new doctors to obtain many prescriptions. As a result, even people who never buy benzodiazepines off the street are still able to obtain their chosen drug of abuse.
Benzodiazepines are often taken as prescribed, in which case they are generally referred to by their official brand names. However, because there is a thriving black market for benzodiazepines, a variety of alternative names have flourished over the decades. Drug dealers and distributors often use code names to avoid detection by law enforcement agencies. Many names have also emerged from the drug culture itself, with many young people finding that colloquial terms of the drug are more exciting than medical terminology. While these names are always changing over time, we’ve attempted to list some of the most common terms for different benzodiazepines below. However, it should be noted that all of these medications are commonly referred to merely as “benzos.”
Some of these names include:
Alprazolam is a short-acting benzodiazepine. The medication has a half-life of 6-12 hours. Under the brand name Xanax, the drug is most commonly prescribed for anxiety disorders, including panic disorder and generalized anxiety disorder (GAD). It is also sometimes used for nausea that occurs among people undergoing chemotherapy. Generally taken by mouth in tablet form, alprazolam is the 21st most common drug prescribed in the United States.
The effects of clonazepam usually begin within an hour after taking the drug. Like alprazolam, it has a half-life of 6-12 hours. It is commonly sold under the brand name Klonopin, but this popular medication is also marketed using many other brand names, and it is also available in generic formulations. It is often prescribed for panic disorders, but clonazepam is also useful for treating seizures and movement disorders such as akathisia. Clonazepam prescriptions are available in multiple forms, including tablets, orally dissolving wafers, drops, and even a solution for intravenous injection.
Chlordiazepoxide is a longer-acting benzodiazepine. The active metabolite in the medication has a half-life of 36-200 hours. Under the brand name Librium, this medication is often prescribed to treat severe and disabling anxiety. As a sedative and hypnotic drug, it is also useful for other conditions, including insomnia, irritable bowel syndrome (IBS), and symptoms of withdrawal from alcohol and other drugs. The drug has multiple properties, including anticonvulsant, amnesic, anxiolytic, hypnotic, and skeletal muscle relaxant effects.
Diazepam is perhaps the most well-known benzodiazepine. After its launch under the brand name Valium in 1963, it quickly became one of the most popular drugs in the United States. Between 1968 and 1982, Valium was the highest selling medication in the country. It remains popular to this day, and the World Health Organization includes it in their List of Essential Medicines. With a half-life of 20-100 hours, diazepam is one of the longer-acting benzodiazepines on the market. It is often prescribed for a range of conditions, including anxiety, alcohol withdrawal syndrome, seizures, insomnia, muscle spasms, and benzodiazepine withdrawal (due to its long half-life). Surgeons and medical professionals often administer it during surgeries and other potentially traumatic medical procedures to induce memory loss. Diazepam can be administered using a range of methods, including oral tablets, through the rectum, and via intravenous injection.
Lorazepam, often sold under the brand name Ativan, is a short-acting benzodiazepine with a half-life of 10-20 hours. It is used to treat anxiety disorders, seizures, nausea from chemotherapy, insomnia, and alcohol withdrawal syndrome. Like diazepam, medical professionals sometimes use it to sedate patients and to induce memory loss during invasive procedures. The medication can be taken orally in tablet formulation, transdermally, and via injection. Lorazepam is on the World Health Organization’s List of Essential Medicines and is currently the 60th most popular medication prescribed in the United States.
Temazepam, which is sold under the brand name Restoril, is a medication prescribed for individuals suffering from insomnia. It is short-acting, with effects usually beginning less than an hour after taking the medication. Temazepam has a half-life of 8-20 hours. Restoril is taken by mouth and is usually only prescribed for short periods of time. While the drug is effective for insomnia, if it is taken for more than 10 days the potential for dangerous side effects increases. These side effects include hallucinations, anxiety, confusion, dizziness, and even increased suicidal ideation. Temazepam should also not be taken alongside opioids.
Triazolam, which is marketed under the brand name Halcion, has a very short half-life between 1.5 and 5.5 hours. Triazolam is actually a triazolobenzodiazepine, not merely a benzodiazepine. The main molecular difference is that triazolobenzodiazepines like triazolam have an additional triazole ring added to the benzene and diazepine rings. While triazolam has more or less identical effects to other benzodiazepines, it is mostly prescribed to treat insomnia. However, because its effects do not last long, it is rarely prescribed for patients who awaken many times throughout the night.
Benzodiazepines are some of the most commercially successful drugs on the market currently. According to the American Psychiatric Association, over 1 in every 8 Americans used benzodiazepines in the last year. This is indicative of surging rates of benzodiazepine use, given that in 2013 and 2014 only 4% to 6% of the population used benzodiazepines. Due to their high potential for physical dependency, it is no surprise that these substances are frequently misused by a large portion of the population. Out of all benzodiazepine use throughout the country, approximately 17% can be considered misuse, meaning it is either not taken as prescribed or taken without a prescription at all. Benzodiazepine misuse is more common among young adults between the ages of 18 and 25. It is also becoming more common among middle-aged individuals. While women are more likely to be prescribed benzodiazepines, men are statistically more likely to engage in drug abuse with them. The American Psychiatric Association also found that the population most likely to engage in benzodiazepine abuse was composed of individuals who already abuse opioids or stimulants. While benzodiazepines are rarely the sole cause of hospital visits, when they are combined with other medications, the risks are significantly increased.
Benzodiazepine abuse, in contrast to misuse (which means ignoring medical directions), is also on the rise. In 2010 alone, approximately 186,000 people began abusing benzodiazepines. As a result, emergency room visits for benzodiazepine-related medical issues have seen a sharp increase of 139%. Between 1998 and 2008 the number of people seeking addiction treatment for benzodiazepine addiction almost tripled. Benzodiazepine abuse and addiction also claims thousands of lives a year. In 2017, 11,537 died as a result of benzodiazepine abuse. The number of benzodiazepine-related fatalities has been on a steady rise in recent years, with only 1,135 people dying in 1999. While the opioid epidemic is currently the most well-known drug-related public health problem, benzodiazepines stand alongside opioids as the two most common drugs implicated in fatal overdoses.
Benzodiazepines addiction can result from recreational drug use, but individuals taking their prescriptions as prescribed are vulnerable as well. Individuals taking benzodiazepines as directed by a medical professional can come to depend upon the relief that benzodiazepine drugs provide, and many patients resist going on a benzodiazepine taper when it is time to wean off the drug. For that reason, more and more psychiatrists are recommending non-addictive alternatives to benzodiazepines for anxiety.
People taking benzodiazepines recreationally often do so because the drug enhances the effects of alcohol and other drugs. Many become emotionally dependent on the relaxing and disinhibiting effects of the drug, much as people come to depend upon alcohol for social situations. When benzodiazepines are used alongside other drugs, it is far easier to become addicted to them. Being intoxicated on other drugs can lead to impulsive use of medications like benzodiazepines. Individuals who use benzodiazepines to deal with withdrawal effects from opioids and other substances eventually come to feel like they need the medication.
One of the primary reasons individuals become addicted to drugs like heroin and cocaine is that these substances cause the brain to release enormous quantities of dopamine. Dopamine is a “reward” chemical chemical that makes people feel euphoria, and it has an important role in the brain’s decision-making and motivation centers. By flooding the brain with dopamine, addictive drugs change drug users’ brains and reinforce drug-taking behaviors. Benzodiazepines, like other addictive drugs, also release enormous quantities of dopamine. However, benzodiazepines are unique in that they actually weaken interneurons in the brain that normally inhibit dopamine production. As such, benzodiazepine abuse causes neurons that produce dopamine to go into overdrive, flooding the brain with dopamine even more consistently than other addictive drugs do. Over time, as drug abusers’ brains grow accustomed to these levels of dopamine, it can become extremely difficult to stop using benzodiazepines.
When an individual has used benzodiazepines for a long enough period of time, benzodiazepine withdrawal symptoms can become a major obstacle to stopping. Even individuals who want to stop because they’re exhausted by benzodiazepines’ side effects (such as depression, confusion, drowsiness, and depression) often find that the withdrawal symptoms are far more painful. People who are accustomed to high doses of benzodiazepines can even suffer life-threatening consequences by quitting the drug without proper medical supervision. Other symptoms of benzodiazepine withdrawal include:
Benzodiazepine use leads to extreme physical dependence, but the withdrawal symptoms can make it not only difficult, but physically dangerous to quit. For anyone hoping to stop using benzodiazepines, it is essential to get the help of a medical professional. At a medical detox center, doctors help people addicted to benzodiazepines by developing a long-term plan for weaning off. They generally recommend a benzodiazepine taper, which usually involves prescribing benzodiazepines at increasingly lower doses. This might involve taking the same medication or a different one (doctors can help with benzodiazepine conversion so there is no need to personally calculate benzodiazepine equivalency). While there is no benzodiazepine antidote that prevents withdrawal effects from occurring, individuals on a supervised taper can withdraw from the drug without the severe and dangerous consequences they might otherwise experience. A medical detox center can also help people suffering from addiction connect with other resources they need, including inpatient addiction treatment centers and sober living homes. While the process of treating a benzodiazepine addiction demands both work and time, long-term sobriety is an achievable goal if an individual has access to the resources of a formal treatment facility.