What are Benzodiazepines?

Since the early 1960’s Benzodiazepines, “Benzos”, have been used by millions around the globe. Benzodiazepine medications were developed to assist in the management of a variety of health issues and disorders such as anxiety, depression, sleep disorders, and panic attacks.  Since then, a variety of alternate medications have been created to help these conditions including, antidepressants and homeopathic substitutes such as melatonin or antihistamines. However, even with these alternatives, the most common remedy for anxiety and insomnia continues to be benzodiazepine based medications. Today, benzos are one of the most commonly prescribed classes of psychotropic medications.

Benzodiazepines are classified as psychoactive drugs that are most often prescribed by a licensed psychologist, neurologist, or primary care physician to patients experiencing unmanageable levels of anxiety. 

Due to the side effects of benzodiazepines, they are also one of the most frequently abused drugs in the United States and worldwide. More than 30% of annual overdoses include a benzo according to the medical examiner’s office and the number of adults actively requesting benzodiazepine based medications is alarming. More than 13.5 million adults actively requested a benzo prescription in 2013. This doesn’t include the number of prescriptions filled illegally.

What are Benzodiazepines Used For?

There are a variety of reasons for a doctor to prescribe a benzo. Likewise, many illicit users turn to these drugs as a way of self-medicating many of the same underlying ailments. Common benzodiazepine uses include: 

  • Treatment of Anxiety: Anxiety tends to lead as the number one disposition that qualifies an individual to be prescribed benzodiazepine medications. Anxiety may appear as panic disorder, Obsessive-Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), phobia, or a general anxiety disorder. In fact, general anxiety disorder is one of the most common mental illnesses in the U.S. impacting 19 million adults aged 18 and older. 
  • Treatment of High-stress levels: Another common reason for benzos to be prescribed is due to high levels of stress. Although stress does not immediately correspond with anxiety by default, it can result from an infinite amount of variables dependant the lifestyle of the user. High-stress levels can negatively impact day to day routines.not managed properly. 
  • Treatment of Panic attacks: Panic attacks often occur in individuals who have experienced a traumatic event or are suffering from Post Traumatic Stress Disorder (PTSD). A doctor may prescribe a rapid-acting benzo to control hysteria when a patient has a panic attack.
  • Insomnia: Benzos may be prescribed if there is a complete lack of sleep or if the user is suffering from unusually poor sleeping patterns altogether.
  • Treatment of Alcohol and Drug Withdrawal: Benzos can be used to ease the cravings and desire to use in those addicted to drugs or alcohol by helping the brain to “regroup” after building a high tolerance to a substance. 
  • Treatment of Muscle Spasms or Tremors: Benzodiazepines can be very useful as a pain management tool for those suffering from uncontrollable muscle spasms.  

Benzodiazepines Dose and Administration

Benzodiazepine medications require a doctor’s prescription. Patients self-administer the medication, usually as needed. Oral administration is most common, but fast-acting benzos are available in spray or injection form. As with other drugs, self-administering a benzo such a Xanax or Ativan can be risky, especially if excessive, repeat use takes place.  Repeated use can lead to addiction if the user is not careful.

Administration of benzos generally includes:

  •  Oral consumption: Conventional benzodiazepines are generally administered in classic form via a tablet or capsule shape that is ingested orally.
  • Intravenously: Benzodiazepines can be administered intravenously for fast-acting results. Reserved for extreme cases when low-blood pressure or abnormal heart rate function must be treated.
  • Intramuscular injection: Fast Acting like intravenous administration, this is the preferred method of doctors in emergency medicine who are treating patients who have extremely violent and unpredictable behavior that can compromise operations.
  • Nasal Inhalation or Snorting Benzos: Another form of benzo self-administration is ingestion via the nasal passage. Benzo nasal spray such as Nayzilam delivers near-immediate results. Illicit administration of this type involves crushing and snorting the medication. Snorting benzos is dangerous and highly discouraged. 

Low dose benzodiazepines such as Klonopin and Ativan are recommended for patients who are new to the world of anxiety management. While the dosages may be classified as low, the effects can be quite impactful. A patient may take low dose benzos 1-3 times per day as needed. It is extremely dangerous to consume a benzodiazepine dose beyond the prescribed limit.

Benzodiazepines List

Before prescribing a benzodiazepine, there are several elements that a doctor will evaluate. Doctors prescribe different benzos based on the type of symptoms the patient is having. For example, a patient struggling with long term anxiety throughout the day may be prescribed lorazepam for its longevity. Likewise, people suffering from random panic attacks might be prescribed diazepam for its almost immediate results. Additional variables that will be considered when prescribing a benzo include dosage amount and the length of time that the patient has been suffering from disclosed symptoms. 

Some of the most commonly prescribed benzos include:

  • Xanax (Alprazolam): By far the most famous Benzodiazepine, Xanax has become a household name and is commonly used to describe all benzos. Xanax treats anxiety and depression. 
  • Klonopin (Clonazepam): Also prescribed for anxiety management and known for being the longest-lasting benzodiazepine on the market, Klonopin effects can last  6-12 hours 
  • Librium (Chlordiazepoxide) In the 1960s Librium was the first benzo introduced to the market. Librium treats substance use disorder. Detox often includes Librium taper protocols.
  • Valium (Diazepam): Known for its fast-acting power, Valium is even more notorious for its dangerous side effects including suicide, seizures, and slowed breathing.
  • Ativan (Lorazepam): Another benzodiazepine with long-lasting power, Ativan is often prescribed in the treatment of general anxiety and PTSD.

What do Benzodiazepines look like?

Benzodiazepines can appear in a variety of different shapes and sizes. 

Some of the most commonly ingested benzos might appear in pill or tablet form. The color and shape often signify to the user the amount of dosage per pill. Not all benzodiazepines are created equal and 1mg of Xanax is certainly not comparable to 1mg of Ativan or Klonopin. A qualified healthcare professional can prescribe a safe dose.

With so many different benzos on the market, it makes sense to familiarize yourself with the most commonly prescribed medications and to have a basic understanding of the physical appearance of each.

  • What does Xanax look like? Those who are familiar with Xanax are aware of the classic white oval or elongated bar shape with the imprint XANAX. However, the appearance may vary on dosage and maybe blue or orange in color as well as triangular in shape.
  • What does Klonopin look like? Klonopin is circular with a standard imprint or it may have a cutout shape. Klonopin pills are green, blue, yellow, white, or pink. The color represents the dose amount.
  • What does Librium look like?: Librium is easily recognized by its iconic capsule form and two-toned shape. The variation in color determines what the dosage of this benzodiazepine is. 
  • What does Valium look like? Similar in appearance to Klonopin, Valium is identified in its circular tablet, with imprinting and cut out shape. Like other benzos, Valium can appear in different colors to clarify the dosage.
  • What does Ativan look like? Ativan can be spotted by its irregular 5-sided shape and unique imprint which allows each consumer to identify the dosage from low to high.

Benzodiazepine Street Names

Illicit benzos may be sought on the streets when a doctor’s prescription is not available.  Medical appointments and insurance coverage is not an option for everyone, and in cases of drug dependence, one prescription order may not last the entire month. Drug users turn to family, friends or local dealers to obtain benzodiazepines on the streets.

Street names describe drugs used illicitly. This helps the speaker to remain under the radar when talking about their drug use. Common benzo street names include:

  • Xanax (Alprazolam) – Xannies, handlebars, Z-Bars, Xan-bars, Blue footballs, planks, bicycle parts or simply Benzos. There are more Xanax street names than any other benzo.
  • Klonopin (Clonazepam) – Referred to as tranks (for tranquilizers), super valium, pins, downers, or benzos, Klonopin street names are as varied as the drug dosages.
  • Librium (Chlordiazepoxide) – Sometimes nicknamed nerve pills, downers, benzos, L’s, blue bombs or ruffies. Librium has many different slang names.
  • Valium (Diazepam) – Valium street names are often used to describe the shape of the pills such as eggs, moggies, vallies, or just benzos.
  • Ativan (Lorazepam): Street names for Ativan are varied and include candy, downers, tranks or benzos.

Benzo Side Effects

Benzodiazepine side effects may be rather extreme and unwanted, and the impact can vary based on each individual. Side effects can be just as lethal as a traditional benzo overdose. The most common side effects that come with benzo use include: 

  • Drowsiness (often sets in immediately after consumption) Compromised motor skills. (extremely dangerous for individuals who operate heavy machinery).
  • Distorted vision or reduced visual range.
  • Sudden weakness in joints and muscles.
  • Confusion.
  • Reduced breathing capacity.

While the list above might seem relatively mild, it is important to not underestimate the power that benzodiazepine side effects can have on the human body.

Unfortunately, it is quite common for benzo users to feel an increase in the frequency of depressive thoughts and they may experience suicidal feelings.

Short Term Use

Neurologists and licensed practitioners endorse the use of benzodiazepine medications when prescribed for use over a period of days, weeks, or a couple of months. A benzo should rarely be prescribed for longer. Patients use benzos as a short-term stepping stone until other behavioral steps can be taken to reduce anxiety.

The short term effects of benzodiazepines are highly dependent on the quantity used and the unique chemistry of the user. Some of the short term effects of benzos that can manifest in users may include:

  • Sleepiness
  • Loss of appetite
  • Memory loss or “foggy brain”
  • Distortion in vision

Long Term Use

Medical practitioners rarely prescribe or condone the use of benzodiazepines long-term. Long term benzo use can have devastating effects.  The long term effects of benzodiazepines can vary greatly from person to person and are similar to the short-term use effects. Unfortunately, the consequences of long-term benzo use can be life-threatening 

Potentially serious long-term side effects of benzodiazepines include:

  • A direct correlation with memory loss including loss of information retention and increased brain fogginess as we; as dementia, in particular, Alzheimer’s disease.
  • Compromised immune system and an increase in infections which may take a toll on the regenerative components of the body. 
  • Overdose resulting from long term use of benzodiazepines which can manipulate the integrity of the brain and its natural function leading to unhealthy dependence and an incredibly high tolerance which can lead to intentional or accidental overdosing.

It is imperative for medical practitioners to moderate the number of times each patient fills their benzodiazepines prescription and be aware of benzo abuse. 

How Long Do Benzos Stay in Your System?

When testing for benzodiazepines via hair, urine, saliva or blood sample, there are several elements that contribute to the quality of the sample that is collected. Factors impacting the sample detection times may include:

  • Age of the user.
  • Gender identity of the user.
  • Both known and underlying medical conditions.
  • Any simultaneous use of other drugs or alcohol.
  • Frequency of benzo use. 
  • The benzo dosage that is used. (High dose benzos can stay in the system longer)

How long a benzo can stay in your system depends on factors relative to the user as well as individual testing factors. Hair tests can detect drugs for much longer than a urine drug test.  The type of test plays a key role in benzo detection times. Hair tests, urine tests, blood tests and saliva testing all have varied detection times for benzodiazepine drugs. Keep in mind that this also varies with the user.

  • How long can benzos stay in your hair?  Benzos have the longest-lasting effect on the hair follicles. The residual effects of benzodiazepine medications can remain in hair follicles for up to three months and in some cases, may be present even longer.
  • How long do benzos stay in your bloodstream? Any indication of benzos can remain in the bloodstream for 24 hours or more depending on unique factors relative to the user. Unfortunately, detection in the bloodstream is more difficult than most other testing methods.
  •  How long do benzos stay in your urine? The most common drug tests are conducted using urine samples. This is often the simplest way to evaluate the quantity and type of benzodiazepines in one’s body. Typically benzos can appear in urine testing for up to 10 days but certain circumstances may cause false negatives and the validity of testing can vary based on the type of test being used.
  • How long do benzos stay in your Saliva? In most cases, traces of benzodiazepines can last up to three days or 72 hours when saliva detection testing is used. Factors such as hydration may play a role in the validity of saliva testing for benzodiazepine drugs.
  • How long do benzos last in Breastmilk? The consumption of benzodiazepines while pregnant is highly discouraged unless such consumption is recommended by a qualified healthcare professional. Your doctor will establish whether the potential benefits of a benzodiazepine medication outweigh the side effects and risks to your baby. If you are prescribed a benzodiazepine a doctor might recommend feeding your baby formula. This can reduce the risk of passing the medication to your baby. Certain side effects may have a lasting impact on the child and may lead to additional conditions that require additional treatment later in life.

Are Benzodiazepines Addictive?

Benzodiazepines are addictive. Opioids are the only known medication that is more addictive than a benzo. Taking a benzo for anxiety can have positive impacts, but reducing your benzo use or abruptly quitting is both difficult and dangerous.

Statistics have shown that individuals who consume benzodiazepines continuously for six weeks or more will become dependent on them. Benzos are depressants that slow down the busy activity of the neurons in the brain to produce a “mind-numbing” effect that relieves the user of any stress or anxiety.  This feeling can become difficult to live without, resulting in a potential desire to continue using.  Benzo addiction is more common in those with an addictive personality or a family history of addiction. 

Long term use of a benzo can lead to physical dependence. Abruptly quitting or cutting back your dose may cause serious withdrawal. Do not quit or cut back your dose if you’re prescribed a benzo. Discuss your intentions with your doctor.  At St. John’s Recovery Place, your safety is our top priority. Call our support line to speak with a professional about you or a loved one’s treatment for benzodiazepine addiction. Our medical team will help to define an appropriate level of care for your individual needs so that you can get well.

Resources

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Johnson, Brian, and Jon Streltzer. “Risks Associated with Long-Term Benzodiazepine Use.” American Family Physician, 15 Aug. 2013www.aafp.org/afp/2013/0815/p224.html.

 

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