Benzodiazepine BZD dependence is a significant public health problem. Apart from the long-term tapering doses of BZD, no others drugs are available for the maintenance treatment of BZD dependence. Baclofen has been used in alcohol and other drug dependence as long-term anti-craving agent. Studies have shown prevalence of long-term benzodiazepine BZD use in general population as Current treatments for chronic BZD use and dependence can be categorized as: a Gradual tapering of the same BZD, b substituting a short-acting agent with a long-acting BZD and slow taper of the same and c using specific medication during detoxification and continuing during maintenance phase.
A number of medications have been tried for long-term maintenance like anti-depressants, anti-epileptics and Azapirones with no clear evidence of efficacy. Baclofen, a stereo-selective Gamma-aminobutyric acid B GABA-B receptor agonist had been used in preclinical and clinical studies as anti-craving agent in cocaine, heroin, alcohol, volatile solvent and nicotine dependence. Withdrawal symptoms were evaluated on Clinical Institute Withdrawal Assessment for Benzodiazepines CIWA-B [ 9 ] with a score of 29, indicating moderate withdrawal and significant craving on subjective evaluation.
Nitrazepam was tapered and stopped over 3 weeks. He remained abstinent from BZD for 6 months and was lost to follow up. He remained abstinent for a follow-up period of a year while on the same dose of baclofen.
A year male presented with alcohol and BZD dependence and substance-induced depressive disorder ICD was taking mg per day of diazepam, which he was unable to stop on account of severe withdrawal. Diazepam was tapered and stopped over 3 weeks. He reported significant reduction in craving and withdrawal symptoms over the next 3 weeks. His depression remitted within a month after starting treatment and he continues to remain abstinent from BZD and alcohol for almost a year.
A year male presented with BZD dependence ICD for 10 years was taking 10 mg of Alprazolam per day and had severe withdrawal on attempted abstinence. He is remaining abstinent on follow-up for a year. He reported no withdrawal over the next 3 weeks of hospital stay.
He has remained abstinent for over 6 months while on the same dose of baclofen. Informed consent was obtained from all patients before starting baclofen. All patients tolerated baclofen well and did not report any side effects on clinical evaluation. There are multiple mechanisms which might explain baclofen's efficacy for BZD dependence. Pre-synaptic GABA-B heteroceptor activation is shown to decrease excitatory neurotransmitter release.
This may explain its efficacy in decreasing withdrawal symptoms[ 8 ]. Activation of these receptors decreases DA discharge at multiple sites like nucleus accumbens and amygdala. This may explain decreased drug-seeking, reinforcing effects and reinstatement effects[ 6 ].
There are certain limitations to our study. As it's a preliminary report there is no control group. Assessment of craving was done based on subjective report. Further, all patients were managed in an inpatient setting which may have influenced the selection and outcome. Our findings provide preliminary support for the use of baclofen in the short-term management of craving and withdrawal in patients with BZD dependence.
Larger controlled trials are required before it can be routinely recommended in BZD dependence. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology InformationU. J Neurosci Rural Pract. Author information Copyright and License information Disclaimer. Address for correspondence: Dr.Benzodiazepines like Xanax are contributing to opioid overdoses. It happened to me.
How we see the world shapes who we choose to be — and sharing compelling experiences can frame the way we treat each other, for the better. This is a powerful perspective. When I woke up from my first heroin overdose, I was submerged in an ice-cold bath. As soon my eyes peeled open, he lifted me out of the tub and held me close.
We were shocked, silent. When I looked around, I was stunned at how our cozy Portland apartment felt more like a crime scene than a home. Rather than the usual comforting aroma of lavender and incense, the air smelled like vomit and vinegar from cooking heroin. Our coffee table usually had art supplies, but now it was littered with syringes, burned spoons, a bottle of the benzodiazepine called Klonopinand a baggie of black tar heroin.
He had to act fast. There was no time for Both drugs are central nervous system depressants, so taking them together can cause respiratory failure. Despite this danger, many heroin users still take benzos half an hour before shooting heroin because it has a synergistic effect, intensifying the high.
Other people died of overdoses — not us. The U. National Institute on Drug Abuse NIDA found in that a staggering 73 percent of heroin users used benzodiazepines multiple times a week for more than a year. Inthe Food and Drug Administration FDA even issued a black-box warning about the dangers of combining the two drugs. Rather than shed light on these dangers, media coverage often blamed overdoses on heroin laced with fentanyl. It seemed like there was only room for one epidemic in the media.
Thankfully, media reports have recently started to raise awareness about the parallels between the opiate and benzodiazepine epidemics. A recent essay in the New England Journal of Medicine warns about the deadly consequences of benzodiazepine overuse and misuse.
Specifically, deaths attributed to benzodiazepines have increased sevenfold over the past two decades. At the same time, benzodiazepine prescriptions have skyrocketed, with a 67 percent increase between and When benzos were introduced in the s, they were touted as a miracle drug and integrated into mainstream society.
Indoctors recognized that benzodiazepines were highly addictive. The FDA classified them as a controlled substance, recommending that benzodiazepines only be used from two to four weeks to prevent physical dependence and addiction. I was intermittently prescribed benzodiazepines for six years, even though I was honest with my doctors about my history of alcoholism.
When I moved to Portland, my new psychiatrist prescribed me a monthly cocktail of pills including 30 Klonopin to treat anxiety and 60 temazepam to treat insomnia. Each month the pharmacist double checked the prescription slips and warned me that these medications were a dangerous combination.
I should have listened to the pharmacist and quit taking the pills, but I loved the way they made me feel. Benzodiazepines smoothed my edges: blotting out traumatic memories of past sexual abuse and assault and the pain of a breakup. In the beginning, benzos instantly blotted out my pain and anxiety.With the introduction of benzodiazepines such as chlordiazepoxide Librium and diazepam Valium in the early s, a new era in the treatment of insomnia and anxiety began.
The benzodiazepines were more effective and far safer than the older drugs — barbiturates, meprobamate, and glutethimide — that had been prescribed for these purposes. For many years, benzodiazepines continued to be the most popular prescription tranquilizers and sedatives.
Since the mids, new alternatives have been assuming some of these roles, but benzodiazepines are not about to leave the stage. More than a dozen benzodiazepines are available by prescription. Benzodiazepines have a common basic chemical structure, and they all increase activity at receptors for the neurotransmitter gamma-aminobutyric acid GABA.
This transmitter inhibits the activity of neurons, slowing down the brain and nervous system, so benzodiazepines are relaxing and calming and promote sleep when taken at bedtime.
Benzodiazepines differ mainly in how quickly they are absorbed, how long their effects last, and how long they take to leave the body. Benzodiazepines are prescribed for severe muscle spasms, tremors, acute seizures, and alcohol and drug withdrawal symptoms. But their main uses are still in the treatment of anxiety and insomnia. Benzodiazepines are uniquely effective when taken by mouth or intravenously for the rapid relief of acute anxiety and agitation.
My Addiction to Benzos Was Harder to Overcome Than Heroin
They can also be used to calm a person facing surgery or terrified by the prospect of an airplane ride. In patients with panic disorder, they reduce anticipatory anxiety and the resulting tendency to avoid places and situations that might provoke a panic attack. Benzodiazepines can also be useful in the treatment of generalized anxiety disorder. Short term use of benzodiazepines is relatively safe, especially compared to many other sedatives and tranquilizers.
They can be used by people with most medical illnesses and in combination with most other medications.
List of benzodiazepines
An overdose of benzodiazepines is almost never lethal. Because benzodiazepines may carry some risk of birth defects, physicians are cautious about prescribing them for pregnant women.
The most common side effect is daytime grogginess or drowsiness, mainly with longer-acting drugs. Short-acting drugs may cause rebound insomnia the night after they are used. At higher doses, benzodiazepines may affect physical coordination and balance, raising the risk of falls and other accidents.
Some benzodiazepines can impair memory or the ability to learn and retain new information. Older people are more sensitive to all these side effects. Alcohol intensifies almost all benzodiazepine side effects, so physicians usually recommend that patients taking benzodiazepines avoid drinking or at least minimize their alcohol consumption.
Some benzodiazepines are metabolized by the same liver enzyme systems that break down the antibiotic erythromycin, protease inhibitors used to treat HIV infection, and calcium-channel blockers used to treat high blood pressure.
When the benzodiazepine is used along with one of these drugs, its effect may last longer than usual. In part because GABA neurons adapt to the presence of the drug and are underactive when it is withdrawn, benzodiazepines can cause physical dependence and a withdrawal reaction.
With longer-acting drugs, the withdrawal reaction usually develops after a month or two; with shorter-acting drugs, it may take as little as a week of daily use. Shorter-acting drugs produce a briefer and more intense reaction that begins within 24 hours after withdrawal. With benzodiazepines that leave the body more slowly, the symptoms begin several days after withdrawal and peak in about a week.
The most common withdrawal symptoms are restlessness, irritability, insomnia, muscle tension, weakness, aches and pains, blurred vision, and a racing heart, in that order. Sometimes these symptoms are difficult to distinguish from returning insomnia or anxiety. Rarely, after use of high doses for a long time or abrupt withdrawal of a short-acting benzodiazepine, a patient may suffer seizures or hallucinations. To ease withdrawal, the dose is reduced gradually.
If the patient has been using benzodiazepines for a long time, the process may take months.Get treatment from the safety and comfort of your home with Telehealth.
Learn More. All benzodiazepine drugs have the potential for abuse, some more so than others. A half-life measures how long a drug takes to break down and exit the body. Low-Potency benzo with a long half-life is weaker than high-potency benzo with a short half-life. Drugs with a shorter half-life, while more short-acting, are often felt more intensely. Drugs with short half-life also create their effect more rapidly. These characteristics make these substances more attractive to recreational drug abusers.
Benzodiazepine drug abusers often prefer short-acting, high-potency benzos, such as lorazepam or alprazolam, due to their fairly rapid and intense high. Though not prescribed in the United States, flunitrazepam Rohypnol is sold illicitly on the streets. Used as a date rape drug, Rohypnol is a high-potency benzodiazepine with a relatively long half-life. Benzodiazepine medications are sedative-hypnotics, meaning they create calming or tranquilizing effects. Because of this, these drugs are prescribed to treat anxiety, insomnia, panic and seizure disorders, and symptoms of alcohol withdrawal.
Benzodiazepine Withdrawal Symptoms and Getting Treatment
Certain ones may also be used as muscle relaxants. The same actions which make these medications valuable within treatment also make them enticing to drug abusers. Benzodiazepines take several forms, including as an extended-release long-acting capsule, liquid, tablet, or orally-disintegrating tablet. Any of these forms may be abused to create a sedated effect or euphoria. When abused, benzodiazepines are taken orally in doses larger and more frequent than would be prescribed.
The medication may also be crushed so that it can be snorted, smoked, or injected. No matter how benzodiazepines are abused, the potential for dependence and addiction runs high. Aside from addiction, benzodiazepine abuse carries with it a host of adverse health effects and dangers. These include:. Like all forms of drug abuse, individuals who abuse benzodiazepines frequently experience an extreme loss of quality of life.No data available. Whether its a question, picture, or information.
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Look for the medically reviewed badge Medically Reviewed Badge on our articles for the most up-to-date and accurate information. Most benzos are intended for oral use yet some people misuse the drugs by crushing up the oral tablets prior to snorting them. Withdrawal from benzos may be extremely unpleasant and potentially dangerous.
Benzo withdrawal may include symptoms of severe anxiety, insomnia, dysphoria, tremors, and seizures. Withdrawal for relatively short-acting drugs may begin after the last dose and persist for week, if not longer. Some of the most common benzo withdrawal symptoms include 1, It might seem logical to immediately stop using a drug to minimize its continued negative health impact, but symptoms like agitation, anxiety ,and panic can become overwhelming when you try stopping cold turkey.
Once the body has grown dependent on a consistent supply of benzos, treatment professionals and rehab facilities may utilize a slow-taper detox program. This allows a person to detox slowly and avoid severe withdrawal symptoms.
Tapering off of a benzo generally involves a doctor prescribing increasingly smaller amounts of the drug over time or changing prescriptions to a longer-acting sedative. For example, if someone is dependent on a very short-acting benzodiazepine like alprazolam Xanaxa doctor may administer an equivalent dosage of a long-acting benzodiazepine like diazepam Valium.
6 Things About Benzo Withdrawal You Might Not Know
Longer-acting benzodiazepines like diazepam allow for less frequent dosing and a more consistent, slower decline in concentration throughout the tapering schedule. Other CNS depressant substances, though they might temporarily resolve some symptoms, would only serve to postpone the eventual onset of the withdrawal symptoms in question, and could introduce additional complications at the point that withdrawal resumes. You can! Although benzo withdrawal can be uncomfortable at best and painful at worst, many others have successfully done it and gone on to live healthy, sober lives.
The editorial staff of DrugAbuse. Our editors and medical reviewers have over a decade of cumulative experience in medical content editing and have reviewed thousands of pages for accuracy and relevance. American Addiction Centers AAC is the leading provider for addiction treatment nationwide, specializing in evidence-based treatment and mental healthcare.
With 9 locations across the U. When you call the helpline displayed on DrugAbuse. Our helpline is offered at no cost to you and with no obligation to enter into treatment. Neither DrugAbuse. For more information, visit americanaddictioncenters. Ready for Drug or Alcohol Rehab? Select your state and then choose Alcohol Treatment or Drug Treatment. Edited By Kindra Sclar, M. Benzodiazepines benzos are an anxiolytic class of drugs that belong to a larger group of substances that can be categorized as central nervous system CNS depressants.
Various benzodiazepine agents are prescribed for a wide range of conditions including anxiety, panic disorder, muscle spasms, tremors, seizures, and insomnia; certain benzodiazepines are also used to manage acute alcohol withdrawal.
What is Ativan? Is Ativan Addictive? Substance Abuse Stats. Data accurate as of Last post by [Buddie] in Re: Looking for help on April 15,pm. Let us help you celebrate being benzo free by starting a thread here. This board is not intended to be used as a blog, but feel free to post updates as you attain significant milestones in your journey to recovery. Last post by [Buddie] in Re: 6o days xanax free!!
We strongly encourage members to post their Success Stories. It can be an invaluable source of inspiration for those still tapering or recovering to read how others have returned to near normal health. When posting your story, you should be: benzodiazepine-free for at least two months; mostly recovered from your experience; feeling positive about the future and this should be reflected in your Success Story.
Last post by [Buddie] in What is happening in you Last post by [Buddie] in Re: Should I just jump o For discussion of remedial action only - none of these are recommended as options unless following very short-term use.
Last post by [Buddie] in Re: In Need of a little Please use this space for the creation of non-personal support groups. Having trouble sleeping? If your problems are caused by benzodiazepine withdrawal or not, please post here with your concerns, tips, and recommendations. You're free to discuss sleep aids and therapies associated with insomnia. Last post by [Buddie] in Re: Insomnia can't slee Last post by [Buddie] in Re: Can long term benzo For issues arising out of poly-drug use and withdrawal; drug interactions; and how other prescribed and over-the-counter medicines might affect benzodiazepine withdrawal.
Last post by [Buddie] in Re: non drowsy antihista Inspirational stories, art, literature, poetry, and the like. What helps make your benzodiazepine withdrawal more bearable? Last post by [Buddie] in Re: Words to lighten our General discussion space for non-support orientated benzodiazepine topics: science, studies, research, theory, issues, or even pet theories.