The benzodiazepine family of drugs is a complex group of substances that have garnered controversy and attention from the media since they broke onto the medical scene in 1957 (Center for Substance Abuse Research, 2005). As with other drugs, more and more people began to use benzodiazepines and negative side effects such as addiction and withdrawal eventually were revealed. (Ashton, 2005, p. 249). Benzodiazepines, however, should not be looked at with a negative connotation. They are relevant and useful medically when used and prescribed responsibly and dependence does not occur (Center for Substance Abuse Research, 2005). Benzodiazepines have both positive and negative aspects that must be examined to form a fair opinion about the drug, its uses and effects.
So, what exactly is a benzodiazepine? They are defined by the National Institute for Occupational Safety and Health (NIOSH) (2008) as: "Any of a class of drug used as antianxiety agents, muscle relaxants, sedatives, hypnotics, and sometimes as anticonvulsants." Under the Controlled Substance Act they are classified as a Schedule IV drug ("Benzodiazepines"). When someone takes a medication that is a benzodiazepine, they may encounter symptoms such as slurred speech, confusion, feelings of fatigue, and gastrointestinal upset. There are many varieties of benzodiazepines used and prescribed today. These include more popularly known medicines such as Xanax, Valium, and Rohypnol. These substances work as depressants in the body, accounting for their sedative effects (Center for Substance Abuse Research, 2005).
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When talking about benzodiazepines, it is important to know that no two benzodiazepines are created equally. They are prescribed for different reasons that will be addressed later and present a variety of withdrawal symptoms when dependence occurs. They can be taken in a pill form, shot into the blood stream using a needle, and some can even be taken sublingually. Finally, benzodiazepines are split into two groups: those that are short-acting and those that are long-acting. The latter will linger for much longer in the body (Center for Substance Abuse Research, 2005).
The first benzodiazepine was created in a laboratory by scientist Leo Sternback. It was not until nearly thirty years later in the 1950s, that benzodiazepines were marketed for medical use as an anti-anxiety medication (Center for Substance Abuse Research, 2005). Research of the drug created new medications for new uses which grew until the 1970s. By then, benzodiazepines topped every other group of drugs in the world, in the times that it was prescribed. Even though prescriptions have trailed off since then, over-prescription is still seen as troubling to many (Ashton, 2005, p. 249).
Benzodiazepines pose benefits for a variety of ailments and disorders. First, they are useful hypnotics for individuals who suffer from insomnia. Like with nearly all cases of benzodiazepine prescription, they should only be taken for a small period of time, with one month being the longest. Benzodiazepines can help with anxiety as well. It should be carefully considered by the doctor that the patient has severe anxiety that is disrupting their life. Again, this should be for the short period of time because benzodiazepines can be highly addictive ("Benzodiazepines," 1997). People who have intense panic attacks or strong phobias that are not eased by other methods could be candidates for benzodiazepine prescription (Ashton, 2005, p. 250).
Another benefit is that benzodiazepines have been shown to drastically relieve muscle spasms that are caused by epilepsy ("Benzodiazepines," 1997). For example, the Epilepsy Foundation of America endorses the use of Valium for emergency, ongoing seizures. It is the gold standard in this situation because Valium is able to go through the blood-brain barrier in a short period of time, saving lives and decreasing the risk of brain damage in the patient ("Medicines for Epilepsy"). These properties are also useful for people who maybe be going through alcohol withdrawal, where convulsions are a possible risk factor (Ashton, 2005, p. 250).
The most important factor when discussing benzodiazepines is having control over the substance. Benzodiazepines stop being beneficial when the patient has to exceed their dosage in quantity or length of time, or they are used no longer for a medical purpose. For example, an individual who uses a benzodiazepine for recreational use, or to help them unwind is not using the drug properly. This can lead to negative effects of the drugs such as addiction, dependence, and losing effectiveness of the drug ("Benzodiazepines," 1997). In her article, "The Diagnosis and Management of Benzodiazepine Dependence," (2005) Heather Ashton writes "Present criteria for substance dependence include tolerance, escalation of dosage, continued use despite efforts to stop and knowledge of adverse effects, other behavioural features, and a withdrawal symptom. Benzodiazepines meet all of these criteria" (p. 250). As seen in these few examples, benzodiazepines are a dangerous group of substances. This is especially true when they are not strictly controlled, overprescribed or misused.
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Being dependent upon benzodiazepines is dangerous because long-term use of these substances can amplify the symptoms they were used to treat. Anxiety problems and depression can be worsened when people overuse benzodiazepines and then begin to experience withdrawal symptoms ("Benzodiazepines," 2007). When benzodiazepines are misused and abused for years there is a risk that this person will then have problems with learning new things and paying attention. There is also the risk that people who take benzodiazepines can hurt themselves through accidents because increased dosages of the medicines can put them in an altered state of mind where they are more likely to fall and hurt themselves (Ashton, 2005, p. 250).
Over-prescription is a problem in the United States that ranges from pain killers to antibiotics. Benzodiazepines are not exempt from this group. Whether it be from overworked doctors or individuals working the system to gain more and more prescriptions, benzodiazepine abuse leads to dependence (Ashton, 2005, p. 249). The United States Drug Enforcement Administration reported that in 1999 approximately 100 million prescriptions for benzodiazepine drugs were written ("Benzodiazepines"). All opinions aside, this is an astonishing number. Over-prescription also leads to the problem of the drugs ending up on the streets. Some varieties can even be conveniently found on the World Wide Web (Ashton, 2005, p. 252). Diazepam, better-known by the name Valium, is one of the more popular types of benzodiazepines that are sold illegally. These are potentially dangerous, controlled substances that do not belong on the streets ("Benzodiazepines").
Why is it that benzodiazepines are so likely to cause dependence? Individuals with no previous problems of abuse can be prescribed for the drugs incorrectly, take the drugs for too long, and find that they are unable to wean themselves away from them ("Benzodiazepines: Risks", 1997). Tolerance is usually the number one cause of dependence in users of benzodiazepines. On some occasions the patient may be prescribed one benzodiazepine that after a period of time that can range for weeks or months, stops giving them they affect they need. A second type of benzodiazepine will then be prescribed. In the end this cycle is keeping the patient from receiving helpful treatment for their ailment, and the patient is unable to withdrawal (Ashton, 2005, p. 250).
Benzodiazepines are different from other drugs that we may think of when we hear words like dependence and addiction. Unlike street drugs like crack and methamphetamines, benzodiazepines are usually taken by people with no intention of getting a high or fix as previously described. This is a problem that needs to be addressed in our society. What a sad thing that some of our health professionals that we pay so much through insurance or even out of pocket, for whatever reason cannot be responsible enough to look out for the well-being of their patients. The patient may not seek treatment and try to quit taking the medications by themselves. In this instance, the withdrawal symptoms of benzodiazepines are no cake-walk and can include high anxiety levels, convulsions, and delirium (Ashton, 2005, p. 251).
People who find that they are dependent upon benzodiazepines do have a high chance of around 80 percent of overcoming it when the process is aided by professionals, and the addict is willing to change (Ashton, 2005, p. 253). Maybe it's a stretch, but this could be seen as a possible benefit of the drugs. People trying to get off the drugs are usually administered less and less of them until the doses are completely stopped. In some cases, if the user stops cold-turkey, especially with stronger benzodiazepines, the withdrawal will be much more intense (Center for Substance Abuse Research, 2005).