We talk pretty frequently about the rising opioid epidemic, but addiction takes many forms. And while overdose deaths related to heroin and prescription opioids continue rising, benzodiazepine addiction poses yet another threat. In fact, many overdose deaths appear to straddle both epidemics, with many addicts mixing both types of drugs. This means that we cannot fight the opioid epidemic without taking on benzo addiction as well. In order to stop the rise of benzos, however, we must first understand their addictive effects.
Benzo addiction, much like opioid addiction, sometimes begins when a patient starts abusing their prescriptions. Of course, many other users obtain their medications illegally. This means that, much like the opioid epidemic, fighting the benzo epidemic through restrictions on medical professionals might adversely affect responsible patients who rely on their medications to get them through the day. Furthermore, these types of restrictions might do little—if anything—to prevent street dealers from peddling their wares. It seems that the best solution, then, would be to fight addiction itself. We do this largely by treating those already addicted, but measures for prevention must be sought as well.
Addiction in all forms should cause concern, so we don’t intend to focus too much on comparing the opioid and benzo epidemics. However, we should note that from 2001 to 2014, rates of overdose deaths due to benzo use actually rose faster than rates of opioid-related overdose deaths. To clarify, rates of death due to opioid addiction still exceed rates of death due to benzo addiction. Nonetheless, with rates of simultaneous opioid and benzo use also on the rise, the benzo epidemic presents a significant problem. Especially since some treatment centers actually use benzos during the detoxification process.
Side Effects of Benzo Addiction
Benzodiazepines are a diverse class of drugs. Also referred to as tranquilizers, they affect the brain’s gamma-aminobutyric acid receptors, resulting in a calming effect. This means that doctors can prescribe benzos for seizures, muscle spasms, anxiety, insomnia and even withdrawal. Examples of benzodiazepines include Xanax, diazepam (Valium), Klonopin and Ativan. Librium, a drug used by many treatment centers to reduce symptoms of alcohol withdrawal, also falls under this classification. While only just over a dozen types of benzos have been approved by the FDA, they are among the most commonly prescribed drugs in America. Unfortunately, their availability makes it rather easy to acquire and abuse them.
While side effects differ slightly from one medication to the next, benzos do share a few major symptoms. Those abusing benzos in high doses may experience dizziness, confusion, slurred speech, blurred vision, poor coordination and respiratory difficulties. Overdose may result in death or coma. When abused over long periods of time, serious problems such as chronic anxiety, frequent headaches, insomnia and even anorexia may occur. Due to the confusion caused by benzos, their use may pose threats other than addiction. For instance, many mix benzos with alcohol to use as a date rape drug. This impairs the drinker’s thinking, as well as their ability to resist their attacker’s advances.
As with many other drugs, quitting benzos after long-term use may result in withdrawal. This typically arises from benzo addiction, whereas withdrawal proves quite rare in cases of normal use. Short-acting benzos may result in withdrawal within a day or two after the most previous use. In most cases, however, it takes between three and four days for withdrawal symptoms to present themselves. Side effects of withdrawal range from mild symptoms such as anxiety to more severe symptoms such as seizures. Detoxing outside of a treatment center or other medical facility may therefore prove dangerous for heavy users.
Benzo addiction presents further dangers when users mix benzos with other substances. For instance, since both benzos and opioids cause respiratory depression, the dangers of overdose increase dramatically when mixing the two types of drugs. Drinking while abusing benzos may also prove deadly. Even the mix of benzos and kratom has caused death in at least one documented user. In short, while benzo addiction is dangerous on its own, it becomes much more fatal when other addictions are at play. And as rates of benzo addiction continue to rise, the odds of users mixing substances becomes much greater.
The Rising Benzo Epidemic
As noted above, the death rate for benzo addiction grew considerably between 2001 and 2014. According to the National Institute on Drug Abuse (NIDA), overdose deaths from benzos grew at a compounded annual growth rate of 13% during that time. This is 2% higher than the growth rate of opioid-related overdose deaths, although only 8,000 deaths from benzos occurred in 2014 compared to 29,000 from opioids. The rates of dual addiction grew as well. Between 2000 and 2010, the National Institutes of Health/NCBI note a 570% increase in patients seeking treatment for the concurrent abuse of benzos, opioids and/or alcohol.
Given what we know regarding the effects of concomitant abuse of benzos and other drugs, these numbers are troubling. Further concern arises when considering the effects of benzo addiction on medication-assisted treatment. If opioid addicts seek treatment without quitting benzos, the effects of mixing benzos with medications such as Suboxone or Vivitrol could prove deadly. The presence of benzos in an addict’s system may also inhibit the effects of Narcan. This means that those who suffer a heroin overdose while also suffering benzo addiction often prove harder to save.
Not only does benzo addiction make opioid addiction more difficult to treat, but benzo addiction proves rather difficult to treat on its own. The medication used during detoxification may cause seizures, and some patients may quit before fully detoxing. This leaves them vulnerable to withdrawal symptoms. Dr. Indra Cidambi, writing for The Fix, notes that many patients ultimately revert back to substance abuse to ameliorate their discomfort. Since detox and treatment for benzo addiction can be a long process, those who choose to stick it out will find themselves undergoing a fair amount of displeasure until the drugs fully leave their system.
Post-acute withdrawal syndrome, or PAWS, presents another issue with fighting the rise in benzo addiction. Since many of those who suffer from benzo addiction also abuse other drugs, the risk of PAWS becomes much greater. Those who experience PAWS do not feel normal without using, even after detoxification. They find themselves experiencing frequent cravings, and their mental obsession remains strong well into recovery. Some believe that PAWS is simply a myth. But whether PAWS exists or not, one thing remains certain—benzo addiction poses a threat. Not only does benzo addiction appear to be reaching dangerously high growth rates, but its potential to exacerbate the heroin epidemic means that something must be done quickly. Unfortunately, this might prove somewhat difficult.
Searching for the Solution
Dr. Cidambi notes three possible ways of fighting benzo addiction, each of which may affect the opioid epidemic as well. The first involves a national prescription database. Many states already use a system like this, but they cannot track prescriptions bought in other states. This allows patients living near state lines to continue filling multiple prescriptions. Furthermore, some worry that these sorts of prescription monitoring programs may actually push addicts onto other drugs. As such, a prescription database alone will not prevent benzo addiction, nor will it ease the opioid epidemic. We require other means.
Another recommendation involves limiting the number of refills per patient. Doctors who prescribe benzos or opiates would only do so for a short period. After this, the patient would switch to another, less addictive medication. Not only would this potentially keep patients from doctor shopping, but would also satisfy the concerns of many medical professionals that neither opiates nor benzos prove as effective when used in long-term treatment. This may, however, adversely affect those who use their medications responsibly. Some patients, especially those suffering from chronic conditions, complain that other medications do not work as well for them. Forcing them to change their prescriptions on behalf of substance abusers may receive some backlash.
Cidambi’s last recommendation is complementary treatment. Those who suffer benzo addiction would receive cognitive behavioral therapy alongside non-addictive drugs to treat whichever co-occurring disorder resulted in their prescription for benzodiazepines. Meanwhile, those suffering opioid addiction would receive similarly non-addictive drugs, as well as physical therapy. Cidambi also makes note of alternate treatment methods. These include meditation, massage therapy and acupuncture. Of course, some patients will find these methods less beneficial than others. For instance, those who turn to benzo addiction as a means of self-medicating for anxiety or insomnia may benefit from meditation. Those who suffer muscle spasms may benefit from massage therapy or acupuncture. But in the end, such modalities can only be recommended on a patient-by-patient basis. And no matter which alternative modalities may be recommended, they should never be used as full replacements for sound medical care.
Ultimately, every prevention method for benzo addiction carries both pros and cons. As medical professionals and government officials continue seeking solutions, we must continue treating those who already suffer. If you or someone you know is struggling with benzo addiction, contact us today for information about our treatment options. The longer you wait, the worse the disease may become. And given the potential health risks of prolonged addiction, the clock is ticking. We must act now to ensure that you or your loved one receive the help you deserve.