There is normally no need to aid breathing in conscious sedation; however, a deeper level of sedation may rarely occur, therefore respiratory and resuscitative equipment should always be available to healthcare providers. One benzodiazepine that’s noteworthy — even though it’s not approved (and illegal) in the United States — is flunitrazepam. This drug is best known as Rohypnol (or by the slang term “roofies”), and it’s infamous for its use as a “date rape” drug. As a result, flunitrazepam is a well-studied drug in the U.S. (and in many places worldwide). Healthcare providers can test for it and treat people under its influence (see below under “What are the disadvantages, side effects and complications that are possible with benzodiazepines?”).
Are benzodiazepines commonly prescribed?
- More studies will need to be carried out on the non-pharmacologic treatment of BZD withdrawal, as it is showing some promise for the successful discontinuation of the drugs.
- PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources.
- However, with this ongoing, widespread use comes the dark reality of BZD dependence [6].
- This same mechanism is also thought to be the cause behind alprazolam’s strong rebound hyperadrenergic effects with cessation [54,55].
During inpatient rehabilitation, patients can interact with doctors, nurses, or therapists daily while living at a rehab facility. Patients may receive 24-hour care to address any co-occurring disorders or lingering withdrawal symptoms, severe benzodiazepine withdrawal syndrome including cravings that might persist after detox. Inpatient rehab often lasts between 30 and 45 days, but the length varies for each client. The assessment determines the severity of misuse and informs the risk of relapse and of harm.
Benzodiazepine Dependence and Addiction
- GAD is the most frequent anxiety disorder, affecting 6.8 million adults or about 3% of the U.S. population, but more than half remain untreated.
- Benzodiazepines, as a class, work on a certain type of receptor found throughout your brain and spinal cord, which make up the central nervous system.
- These 5 subunits include 2 alpha subunits, 2 beta subunits, and 1 gamma subunit.
- Before you drive, go back to work, use heavy tools and machinery, or participate in other potentially dangerous activities, talk to your healthcare provider.
Despite this, numerous studies report usage extending for months into years or even decades in many users [9]. Additionally, according to several studies, BZD use increases with age, with long-term usage most prevalent in the 65 and older population [16]. Long-term use is defined as two or more months at a therapeutic dose and when used long-term, BZDs pose potential harmful effects. Some additional side effects of concern include aggressive behavior and expressing anger towards others in between 1% and 20% of users [17]. The main driving factor for dependence is the development of tolerance, causing users to need increasing doses for the same symptom relief [18].
- Benzodiazepines are commonly prescribed drugs in outpatient and hospitalized patients.
- However, this study was limited by a small sample size, so further randomized clinical trials need to be conducted to assess the efficacy of gabapentin treatment in BZD -dependent MMT patients [68].
- Prescribing interventions, substitution, psychotherapies and pharmacotherapies can all contribute.
- Patients with a lower risk of relapse are those taking a daily dose of 10 mg diazepam equivalent or less at the start of tapering, and those who have made a substantial dose reduction themselves before the start of tapering.
- Benzodiazepines are medications that make your nervous system less active.
What are benzodiazepines used for?
The relationship between hypnotics and cancer was expanded upon by Kripke et al. They found a 35% increased chance of developing a new non-melanoma cancer in users of hypnotics [48]. In agreeing with some of the studies above, there was also a 4.6-fold increase in the hazard of death in patients on hypnotics over 2.5 years [48]. This is more significant than the study by Weich et al. [47] which found a 2-fold increased hazard of death in 7 years. It was also reported that the risk of death in patients using less than 18 pills per year is increased by 3.6-fold [48].
5. WITHDRAWAL MANAGEMENT FOR STIMULANT DEPENDENCE
Flumazenil administration should be prudent, as it may precipitate withdrawal seizures. Of note, one multicenter trial found that patients with excessive benzodiazepine ingestion could become “re-sedated” after flumazenil began to wear off. Many clinical studies have been conducted to assess the severity and treatment of withdrawal systems, while others assess more long-term effects of chronic BZD use. Current studies are aimed to decrease this rebound anxiety effect while also decreasing relapse into BZD use using different medications, counseling, BZD dosing strategies, or different tapering techniques.
4. Special Populations and Withdrawal
In general, at higher doses (e.g. greater than 10 mg diazepam equivalents per day) the dose may be tapered more rapidly. Once the patient achieves 10 mg the dose should be tapered more slowly (e.g. 5 mg twice daily for two weeks, then once daily for two weeks, and then 2 mg daily for two weeks and then cease). Benzodiazepines are a class of drugs that act upon benzodiazepine receptors in the CNS.
Interestingly, a lower prevalence of withdrawal symptoms was noted in the experimental group without any change in pharmacologic treatment from control group [73]. However, this study included a small sample size, so a larger study using this standardized counseling method would increase the validity of the results of this study [73]. More studies will need to be carried out on the non-pharmacologic treatment of BZD withdrawal, as it is showing some promise for the successful discontinuation of the drugs. Many medications have been tested to alleviate withdrawal symptoms and make it easier for patients to discontinue BZD since a gradual taper does not always lead to successful discontinuation of the drug.
- Patients should be monitored 3-4 times daily for symptoms and complications.
- Behavioral therapy and treatment with the antidepressants such as selective serotonin-reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and/or behavioral therapy are first-line treatments.
- Some people use these drugs for recreational purposes without the supervision of a medical professional, which can be dangerous.
Other important indications for the use of BZDs include the treatment of catatonia, seizure disorders, and alcohol and BZD withdrawal. The drug class is the mainstay of treatment for catatonia, which is characterized by postural rigidity, immobility, purposeless activity, and disturbances in one’s consciousness [10]. Catatonia presents in populations suffering from bipolar disorder, schizophrenia, or a variety of medical conditions. BZDs act on the CNS to exert anxiolytic and sedative effects and, together with electroconvulsive therapy, are the mainstay therapy for catatonia [13]. Benzodiazepines are a class of drugs known as central nervous system depressants, used to treat various mood disorders and other health conditions, including seizures, insomnia, and alcohol withdrawal. One view is that many of the short-term effects continue into the long-term and may even worsen, and are not resolved after stopping benzodiazepine usage.
To prevent or mitigate these effects, it’s recommended people seek medical assistance so that doctors and nurses can monitor patients and supply symptom-blocking medications if needed. Benzodiazepine abuse is common in those on methadone maintenance treatment (MMT), so special consideration must be taken for those withdrawing from the drugs while on MMT [68]. These patients are more likely to die from methadone toxicity because of the synergistic effects of methadone and BZD [68]. Additionally, these patients are more likely to have comorbid substance use disorders and anxiety disorders so it can be harder to find an efficacious treatment for their withdrawal symptoms [68]. One potential candidate for treatment of withdrawal symptoms in these patients is gabapentin, which works similarly to the neurotransmitter GABA [68].
