Benzodiazepines and Their Use

For someone dealing with conditions such as anxiety, insomnia, and prolonged seizures, benzodiazepines can offer fast-acting relief. However, these central nervous system depressants also carry risks, as misuse can lead to dependence and addiction, making medical oversight essential. Understanding benzodiazepine uses, side effects, and the potential for addiction can empower people to make informed choices and reduce the potential for harm.

What are Benzodiazepines?

Benzodiazepine medications (aka benzos) are sedative-hypnotic drugs that enhance the effect of gamma-aminobutyric acid (GABA), a type of neurotransmitter that slows nerve activity in the brain and body. This produces a short-term calming effect that helps ease anxiety, muscle tension, and sleep disruption ^[1]. Given their potential benefits, a host of benzodiazepines are prescribed for therapeutic use. In fact, according to the 2023 National Survey on Drug Use and Health (NSDUH), an estimated 23.89 million people aged 12 or older used prescription benzodiazepines in the past year ^[2]. 

That said, the relaxing and potentially euphoric effects of benzodiazepines also mean they can be habit-forming. Among those who use prescription benzodiazepines, 3.69 million reported misusing them ^[2]. Perhaps not surprisingly, the U.S. Drug Enforcement Administration classifies most benzodiazepines as Schedule IV controlled substances. This means they have accepted medical uses but also carry the potential for misuse and dependence, and possession without a prescription is illegal ^[3]. 

Significantly, benzodiazepine misuse is also associated with potentially fatal overdose and dangerous interactions with alcohol and other sedative drugs. Plus, benzodiazepines have the potential to be used to perpetrate sexual assault. Specifically, rohypnol pills (aka roofies) are linked to sexual assaults during which the victim is rendered unable to understand, resist, or remember the experience ^[1]. Thus, while these medications can offer significant symptom relief when used appropriately, they also require care and oversight. 

Common Benzodiazepine Uses

Typically administered via oral and intravenous routes, benzodiazepines are most commonly prescribed to treat conditions that involve heightened nervous system activity. Thanks to their fast-acting effects, they can bring noticeable relief within minutes to hours ^[1]. Common conditions treated with benzodiazepines include ^{[1] [4]}: 

• Alcohol withdrawal syndrome
• Anxiety and panic disorders 
• Insomnia
• Prolonged or repetitive seizures
• Spastic and seizure disorders
• Surgery-related sedation

Various prescription substances are regularly used for off-label purposes, which means the medication is prescribed for a condition that the Food and Drug Administration hasn’t approved. Off-label uses for benzodiazepines include delirium, delirium tremens, sleep disorders, Tourette syndrome, tremors, tics, and tardive dyskinesia ^[4].

While benzodiazepines offer significant therapeutic benefits, they’re generally intended for short-term use. With prolonged use, the brain may begin to rely on the drug to regulate its activity, which can lead to dependence, withdrawal, and addiction. Because of these risks, medical supervision is essential ^[5]. 

Types of Benzodiazepines

Benzodiazepines fall into two main categories based on how long their effects last in the body, namely short-acting and long-acting formulations. The duration of action influences how these medications work for different conditions ^[1]. 

Short-acting benzodiazepines take effect quickly and remain active in the body for shorter periods. These medications help with conditions requiring immediate relief, such as panic attacks and acute insomnia. Meanwhile, long-acting benzodiazepines stay in the body longer, providing extended symptom relief. These medications help people manage chronic conditions like generalized anxiety disorder ^[1]. 

Some of the most commonly prescribed benzodiazepines and their FDA-approved therapeutic uses include ^[1]: 

• Alprazolam (Xanax): Anxiety, panic, and premenstrual dysphoric disorder
• Clonazepam (Klonopin): Agitation, anxiety, and seizures
• Diazepam (Diastat, Valium, Valtoco): Muscle spasms, alcohol withdrawal syndrome, seizures, surgical pre-anesthesia
• Lorazepam (Ativan, Loreev): Seizures, anxiety, phobias, chemotherapy-related nausea and vomiting, surgical pre-anesthesia
• Quazepam (Doral): Insomnia and sleep disturbances
• Temazepam (Restoril): Insomnia
• Triazolam (Halcion): Insomnia

Each benzodiazepine has its risks and duration of onset and effectiveness, making professional oversight essential when choosing the appropriate medication. The right option depends on both the condition being treated and the person’s specific needs and history.

Benzodiazepine Side Effects and Risks

Each type of benzodiazepine is slightly different, and as such, side effects vary by substance. However, as a drug class, benzodiazepines are associated with the following common adverse effects, which can range from mild to severe ^[4]: 

• Confusion
• Drowsiness
• Fainting 
• Headache
• Nausea, vomiting, and diarrhea
• Respiratory depression and arrest
• Tremors

Long-term benzodiazepine use can lead to more significant health concerns such as cognitive impairment, liver injury, and hypertension. Additionally, specific populations face heightened risks. For example, among older adults, benzodiazepines offer an increased risk of cognitive impairment, falls, and accidents. Meanwhile, use of some benzodiazepines during pregnancy is associated with various forms of fetal risk, and use while breastfeeding should generally be avoided ^[4].

Benzodiazepines can also produce dangerous effects when mixed with alcohol, other benzodiazepines, and various substances that cause sedation (e.g., barbiturates, opioids, and alcohol) ^[4].  Polysubstance use, which is when two or more substances are intentionally or unintentionally taken together, is never safe, as the combined effect can be stronger and more unpredictable than expected ^[6]. However, when benzodiazepines are combined with other sedating substances such as opioids, it can lead to severe respiratory depression and death ^[4].

For these and other reasons, healthcare providers closely monitor side effects and use. Any new or worsening symptoms should prompt immediate discussion with a medical professional to ensure safe and effective treatment.

Misuse and Addiction Concerns

While benzodiazepines can offer short-term relief from distressing symptoms, they’re also commonly misused. Misuse may involve taking higher doses than prescribed, using someone else’s medication, or mixing benzodiazepines with other substances to intensify their effects ^[4].

When misuse escalates, the body may no longer respond to the drug in the same way, requiring higher doses to achieve the same effect. This cycle often leads to physical dependence, where stopping or reducing use triggers withdrawal symptoms. In some cases, misuse progresses into a condition known as sedative, hypnotic, or anxiolytic use disorder, a diagnosable substance use disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders ^[7].

Benzodiazepine Withdrawal

When someone has developed dependence and abruptly stops taking benzodiazepines or significantly limits their use, their body may experience withdrawal as it adjusts to functioning without the drug. Physical symptoms of benzodiazepine withdrawal can include headaches, seizures, weakness, fatigue, tremors, gastrointestinal symptoms, and more. Additionally, psychological symptoms can include anxiety, insomnia, depression, hallucinations, delirium, and psychosis ^[5].

Due to these risks, medical supervision during withdrawal and detox is essential. Healthcare providers typically create personalized tapering schedules, gradually reducing the medication dose over time to minimize withdrawal symptoms and ensure safety. This careful approach helps prevent severe complications while supporting the person through the withdrawal process.

Illicit Distribution and Overdose

Illicit distribution of benzodiazepines adds another layer of concern. Although these medications are often legally prescribed, they are also widely diverted for nonmedical use and frequently sold illegally. Illicit substances are often obtained through forged prescriptions, online purchases, or theft from pharmacies or patients ^[3].

What’s more, illicit drugs often comprise counterfeit pills made with a mixture of potentially dangerous substances (e.g., fentanyl and xylazine). These fake medications pose severe risks, as people may unknowingly consume potentially lethal combinations or doses of substances. 

If someone is suspected of experiencing an overdose, the Centers for Disease Control and Prevention recommends the following steps ^[8]:

• Call 911 and administer an overdose reversal medication like naloxone (if available).
• Keep the person awake and breathing.
• Lay the person on their side to prevent choking.
• Stay with the person until emergency assistance arrives.

Benzodiazepine Addiction Treatment

While benzodiazepine addiction can be challenging, recovery is possible with proper care and support. The journey begins with a thorough medical evaluation to determine the most appropriate treatment approach. Following evaluation, treatment options range from intensive inpatient care to flexible outpatient programs. 

As the most intensive level of care, residential programs offer comprehensive support in a controlled environment. For those who can maintain daily responsibilities, partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), and standard outpatient programs provide structured support with varying levels of flexibility. Regardless of the level of care, successful recovery is built on individualized treatment, medical supervision, and ongoing support tailored to each person’s unique needs.

Safe Benzodiazepine Use 

Safe use of benzodiazepines starts with following prescribed dosages and treatment durations. Healthcare providers typically recommend these medications for short-term use to reduce the risk of dependence. However, people taking benzodiazepines must also stay alert to signs of developing dependence, such as needing higher doses to achieve the same effects, experiencing increased symptoms between doses, or thinking about the medication frequently. Meanwhile, regular check-ins with medical providers help monitor effectiveness and address any concerns that arise during treatment ^[1].

For some conditions, alternative treatment options can complement or replace benzodiazepine use. Other medication classes, such as certain antidepressants, can help manage anxiety with less risk of dependence. Nonmedication approaches, including cognitive behavioral therapy, relaxation techniques, and lifestyle modifications, provide additional tools for managing symptoms. These alternatives often offer long-term benefits without some of the risks associated with benzodiazepine use ^[1].

Finding Balance with Benzodiazepines

When used as prescribed, benzodiazepines can treat various conditions and improve quality of life. Treating everything from anxiety and insomnia to seizures and alcohol withdrawal, they serve as valuable tools in short-term care. However, with these benefits come risks, especially when use extends beyond medical guidance or these substances are misused.

The path to optimal health often involves balancing the benefits of these medications with proper precautions. By working closely with healthcare providers, following prescribed guidelines, and staying informed about potential risks, people can maximize the therapeutic benefits while maintaining their safety. With the proper care and information, people can make empowered choices, balancing symptom relief with long-term well-being.