Benzodiazepine Drugs: Unraveling the Complex Story of Benzodiazepine Use and Misuse A Closer Look
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| Benzodiazepine Drugs |
Benzodiazepines are a class of psychoactive drugs known as minor tranquilizers. Some common examples include diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and temazepam (Restoril). They work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. This calming effect is what allows benzodiazepines to treat conditions like anxiety, insomnia, agitation, seizures, and muscle spasms. Benzodiazepines were first introduced in the 1960s and quickly became a popular pharmaceutical option due to their safety and effectiveness compared to older sedative hypnotic drugs like barbiturates. However, as time went on it also became apparent that benzodiazepines carry risks of dependence, abuse, and withdrawal symptoms upon discontinuation that requires careful medical management.
Approved Medical Uses
Risks of Benzodiazepine Drugs
While benzodiazepines are generally very safe when used as prescribed in the short term, tolerance and physical dependence do develop upon continuous long-term use. Dependence refers to the body adapting to the drug's presence such that discontinuation results in withdrawal symptoms. With regular benzodiazepine use, there comes a point where the brain stops producing its own calming neurotransmitters in expectation that the benzodiazepine will provide the inhibitory effect instead. Abrupt cessation at this stage risks experiencing rebound anxiety, insomnia, tremors, seizures, and in severe cases, delirium or psychosis. As a result, doctors usually want to slowly taper the dosage over weeks or months to allow the brain to gradually readjust neurotransmitter levels in the absence of the drug.
Benzodiazepines also carry a risk for misuse and abuse despite having a lower addiction potential than opioids. This typically occurs when the medication is taken at higher than recommended dosages or in a manner not intended by the prescribing doctor such as route of administration (IV instead of oral). Dependence and tolerance elevate the risk for developing a substance abuse disorder as the individual feels compelled to obtain more of the drug to avoid uncomfortable withdrawal effects or to achieve the same desirable effects. Vulnerable groups like those with mental health issues or a family history of addiction require extra caution with benzodiazepines. Street names for misused benzodiazepines include "candy", "downers", and "sleeping pills".
Long-term Effects and Alternatives
Regular long-term benzodiazepine use for several months or years is tied to detrimental effects on cognition, coordination, sleep architecture, metabolism, and increased risks of road traffic accidents, falls, fractures. Studies done on long-term users have found noticeable impairments in short-term memory, learning new information, psychomotor performance, and decline in general cognitive function that persisted even after drug discontinuation. Falls and fractures become a greater risk for older adults prescribed benzodiazepines long-term. To minimize harm, most doctors recommend using benzodiazepines at the lowest effective dose for the shortest possible duration and exploring alternative treatment options whenever feasible.
Non-drug options tried before or instead of benzodiazepines include relaxation techniques, cognitive behavioral therapy (CBT), mindfulness meditation, yoga, controlled breathing, biofeedback, acupuncture, herbal supplements like kava kava or valerian root, and lifestyle adjustments to improve sleep hygiene for insomnia. CBT in particular has similar efficacy to benzodiazepines for anxiety disorders but with less risk of issues like dependence forming. Combination approaches often work best with both drug treatment and a psychotherapy element provided together. When discontinuation is planned, tapering the benzodiazepine slowly under physician guidance paired with cognitive behavioral coping strategies offers the highest chances of success versus abrupt cessation.
Special Populations and Interactions
Benzodiazepines must be used cautiously or avoided altogether in certain at-risk groups like pregnant women, teens/young adults, older adults, those with lung disease or sleep apnea, alcoholics, and patients taking other central nervous system depressants. Combining benzodiazepines with opioids, antidepressants, antihistamines, or alcohol can be deadly due to additive sedative and respiratory depressant effects. Even prescription cough syrups or allergy medications taken at the same time as a benzodiazepine require awareness of potential interactions. Pregnant women especially risk fetal harm and withdrawal symptoms in the newborn if exposed to benzodiazepines during pregnancy or breastfeeding. Benzodiazepines are not a first-line option for treating anxiety or insomnia in vulnerable groups whenever safer alternatives exist.
Benzodiazepines are valuable pharmaceutical aids used worldwide to
treat many conditions when prescribed appropriately. However, they also present
clear risks primarily related to dependence, abuse, and cognitive and
coordination deterioration with long-term regular use that requires judicious
monitoring by medical experts. Non-drug options and alternative treatments
should be attempted before or in addition to benzodiazepines when feasible. And
special care is needed for high-risk populations in whom benzodiazepines may
pose disproportionate dangers. With informed medical guidance, benzodiazepines
maintain an important role, but their risks necessitate a comprehensive
understanding of how to use them safely and for minimum durations possible.
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