Benzos: An Unseen Part of the Opioid Crisis

Today, benzodiazepine class drugs such as Klonopin, Librium, Xanax, and others are critical tools in modern healthcare. These drugs, sometimes called benzos, are among the most prescribed in the United States today, being the first-line medication for sleep disorders, anxiety, muscle spasms, and epilepsy. These drugs are also prescribed off-label for a wide variety of other conditions.

But their ubiquity has led to concerns that they are being prescribed too often. One 2020 report published in New Scientist stated that over a quarter of all office-based doctor visits result in a prescription for benzodiazepines. Over 12 percent of all Americans also used these medications in the past year, with almost 18 percent of these uses classified as misuse.

Risks of benzodiazepine misuse

Unfortunately, all benzodiazepines can be habit-forming, especially when they’re not used as directed. And because they’re prescribed so often, the potential for misuse and access by unauthorized persons is also correspondingly high. And in contrast to other commonly prescribed but potentially addictive drugs like amphetamines, benzodiazepines have potentially lethal withdrawal symptoms when used incorrectly.

Here in Boston, benzodiazepine misuse has been associated with a rising number of fatalities, mostly when these drugs are taken with alcohol or opioids, with which they have a strong synergistic effect. Drug rehab centers in Boston also report a steadily rising increase in admissions for benzodiazepine use disorder or BUD.

Benzodiazepine misuse in America

As with opioid drugs, benzodiazepines are not likely to go away soon. Their value in legitimate uses is undeniable, and they are, for most applications, superior to the even more habit-forming and dangerous barbiturate drugs they largely replaced starting in the mid-1950s.

By the 1970s, benzodiazepines started seeing widespread recreational use. It would take authorities more than a decade later to enact serious controls on their use. Regardless, the legitimate prescribing and black market availability of these drugs also increased sharply since the 2000s.

By 2018, benzodiazepines were involved in 10,724 drug overdose deaths, mostly in combination with alcohol and opioids. Overall, this is a low death rate proportional to the close to the over 100 million yearly prescriptions for these drugs. Deaths from benzodiazepine-only overdoses and withdrawals are also quite low, though much higher than many other widely prescribed drugs excepting opioids.

The dangers of combined drug use

Boston has been particularly hard-hit by a wave of lethal opioid overdoses in the 2010s. What many people don’t realize is that perhaps close to a third of these deaths may have been survivable had the individual not been taking benzodiazepine drugs as well.

The National Institute on Drug Abuse says that as much as 30 percent of all opioid overdoses involved benzodiazepine class drugs. Considering that the CDC estimates about 136 Americans die from opioid-related overdoses daily, that is a lot of people who would still be alive, had they not taken benzodiazepines as well.

What are the effects of benzodiazepines?

The effects of benzodiazepines are often compared with alcohol, with which it shares similar effects. Different benzodiazepine drugs often only differ in their onset and duration. Physicians will typically match these drugs for a specific application. For example, a doctor may prescribe Klonopin for sleep disorders because of its comparatively long duration while preferring to prescribe Xanax for panic attacks because of the fast onset. However, all these drugs can be used interchangeably, up to a point.

When used as directed, benzodiazepines can effectively control anxiety and panic attacks, stop epileptic seizures, relax stiff muscles, and improve the quality of sleep.

However, there are several side effects, including the following:

• Confusion
• Memory loss
• Depression
• Fatigue
• Slurred speech
• Euphoria
• Detachment
• Loss of sex drive
• Vomiting
• Diarrhea

Higher doses, long-term misuse, and combination drug use can intensify those effects and cause the following:

• Excitability
• Aggression
• Mood swings
• Paranoia
• Labored breathing
• Coma
• Benzodiazepine use disorder

Conclusion

Benzodiazepines are mostly safe when used as directed. The odds of serious negative effects are extremely low for most people that use them, even though about a fifth of all use is technically misuse. This can be a testament to the relative safety of these drugs.

However, the fact remains that benzodiazepines can be habit-forming. Illicit use without a prescription is especially dangerous, as the types and dosages of these drugs have to be tailored for individual use cases to be safe. There is also the unfortunate fact that people with anxiety issues, the ones who benefit the most from these medications, are also more likely than the general population to develop compulsive substance-taking behavior.

Given that there are very few effective alternatives to these drugs, we will probably not see them go away. The biggest risk associated with benzos — combined drug use — may never truly disappear so long as opioids and alcohol remain commonplace and easily accessible.

If you feel that you or a loved one are might have a problem with benzodiazepines, please contact a qualified treatment specialist.