Benzodiazepines

The benzodiazepines are a class of psychoactive drugs which, as their long name (often abbreviated as “benzo” or the initials BZD — henceforth we refer to them by the latter name) suggests, have a fusion of rings of benzene (a hydrocarbon compound) and diazepine (a group of heterocyclic compounds containing two nitrogen atoms). Drugs that fit in this group include cinolazepam, etilozam, diazepam, flurazepam, clobazam, zolpidem and lorazepam. Most of these drugs are marketed under various trade names — lorazepam, for example, has at least six, among them Lorabenz and Ativan. They have only been in existence since 1955, when the first drug of the group was discovered by accident, and are commonly prescribed to treat various mental illnesses, including insomnia, panic disorder, seizures and symptoms of alcohol withdrawal. Many people use them for recreational purposes and they can be highly addictive. In this article we shall take a look at some of the medical uses of BZDs, their effects on the nervous system and common effects of addiction.

Medical uses of the drugs

BZDs have been shown to be markedly effective in treating generalized anxiety disorder in the short term; in the long term, though, their efficacy has yet to be demonstrated, and the National Institute for Health and Clinical Excellence does not recommend giving them to patients for more than two to four weeks, after which antidepressants should be used instead. Their use for more than that length of time on patients who have anxiety or insomnia is likewise not encouraged because of their potential to cause dependence.

The drugs are, on the other hand, the preferred method of treatment for alcohol withdrawal syndrome. In particular delirium and seizures can be subdued by them. However, only one BZD — lorazepam — is absorbed by the muscles in a predictable way, so it is this drug that doctors prescribe for acute seizures. In cases of anxiety, BZD may be used “as needed,” that is, when the condition is reaching its lowest point.

Other applications of BZDs include:

  • muscle spasms
  • relief of anxiety during the few hours immediately preceding a surgical operation
  • hallucinogen-induced acute panic
  • obsessive-compulsive disorder (How well it can work here has not been conclusively proven.)
  • parasomnia in various forms (clonazepam only)
  • medication prior to various medical and dental procedures

The long-term use of BZDs is in general very controversial because the drugs can cause dependence. Addiction and withdrawal symptoms will be discussed in detail in a later section.

Physical and mental effects of the drugs

BZDs have numerous sedative, hypnotic, muscle relaxant, antioxidant and anti-anxiety properties. They work as they do by boosting the effect of gamma aminobutyric acid — the most important of the inhibitive neurotransmitters — at the GABA – A receptor, which hyperpolarizes the neurons.

Harmful effects and addiction

As mentioned in the previous section, BZDs can serve as sedatives and sleep-inducing drugs. As with all medications, these effects can be magnified when they are taken in larger doses — they can cause drowsiness and decreased attentiveness which, in turn, can result in accidents, particularly in elderly people. Driving under the influence of BZDs is likewise extremely dangerous.

Among the other dangers that can result from overdoses of BZDs are the following:

  • irritability, aggression and violence
  • impulsive behavior
  • other so-called paradoxical reactions (effects opposite those that one might normally expect), which tend to be most common among those who use the drugs for “recreational” purposes
  • depression
  • disinhibition
  • anterograde amnesia
  • cognitive impairment
  • agoraphobia
  • erectile and other sexual dysfunctions, loss of the sex drive
  • loss of interest in one’s former recreational activities
  • changed perceptions of oneself and others

BZDs can become addictive if taken in large enough amounts. Eventually, the addict may develop a tolerance for the drugs, so that he or she needs to take them in ever-increasing dosages in order to achieve the same effects. If denied the drugs, addicts often experience unpleasant withdrawal symptoms, among them:

  • tremors
  • insomnia
  • fearfulness
  • depression (less common)
  • psychosis (less common)
  • muscle spasms
  • seizures (less common)
  • agitation
  • delirium tremens (less common)
  • suicidal behavior (less common)
  • gastric problems
  • irritability (less common)

Physicians also speak of “rebound symptoms,” which is when the symptoms that the patient had experienced before taking the BZDs return in an even worse form — unlike withdrawal symptoms, which are completely new. Both are clear signs that the individual has become physically dependent on the drug.

The dangers of BZDs can be aggravated through combination with other drugs. If used in tandem with alcohol or opioids, for instance, they can cause brain and respiratory functions to plummet — and the abuser can go into a coma or even die as a result. Users often combine BZDs with other drugs in the hopes of producing effects that they could not otherwise achieve.

Statistics on BZD abuse

Studies have revealed that in the period from 2008 to 2009, 90,000 New Yorkers age 12 and older used BZDs either without a prescription, or with a prescription but not in the manner prescribed. This amounted to 1.4 percent of the city’s population. The same year, two percent of teenagers in middle and high school reported that they had used BZDs at least once. Such abuse was most common among those who lived on Staten Island, where 1.4 percent did so — nearly twice as many as in the other boroughs. In 2010, the highest percentage ever of New Yorkers in the age range 18 to 25 used the drugs for nonmedical purposes. For more statistics on the misuse of BZDs in New York City.

Regarding similar figures for the country as a whole — the highest rates of BZD abuse have occurred among those aged 18 to 29, and this is true both among the general population and among those who frequent nightclubs. Many among both segments of the populace have abused other drugs as well. BZDs are indeed among the prescription drugs with the greatest potential for misuse. Legally, they are classified as Schedule IV drugs, even when they are not on the market. This means that they have a relatively low potential for abuse and are accepted for medical use.

Treatment for BZD addiction

As with all types of drug addiction, BZD dependence is treated by counseling and, if necessary, medication. The withdrawal symptoms are so severe that only an addiction specialist or other trained person should attempt to detoxify an addict.