Benzodiazepines Drugs

Understanding Benzodiazepines in the USA

Benzodiazepines, often known as “benzos,” represent a class of medications frequently prescribed in the USA for various medical conditions. These drugs function as central nervous system (CNS) depressants and modify brain chemistry in a manner similar to opioids and alcohol. While benzodiazepines can be effective for short-term treatment, their efficacy may diminish over time, which can lead some individuals to increase their dosage beyond what is prescribed, thereby posing a risk for developing an addiction. Moreover, some users may combine benzodiazepines with other substances to amplify their effects or to mitigate the impact of stimulants like methamphetamine. Such combinations are highly dangerous and can result in overdose or even death.

Benzodiazepines are medications often prescribed in the USA

A study led by Maust et al. in 2019, which utilized data from the National Survey on Drug Use and Health, estimates that approximately 30.6 million adults in the USA use benzodiazepines (benzos) annually. Of these users, about 25.3 million take these medications as prescribed, while around 5.3 million engage in misuse. The findings indicate that individuals with a history of misuse or dependence on prescription opioids or other CNS depressants are at an increased risk of benzodiazepine misuse. It is also common for individuals without a prescription to obtain these drugs from friends or family members. Notably, the research suggests that a significant number of adults aged 50 and older use benzodiazepines primarily to assist with sleep. The overall conclusion indicates that the actual rate of benzodiazepine use in the U.S. is higher than previously reported, with nearly 20% of users engaging in misuse.

Mechanisms of Action

Benzodiazepines work by enhancing the activity of gamma-aminobutyric acid (GABA), which is the primary inhibitory neurotransmitter in the CNS in the USA. This interaction helps to reduce neuronal excitability, resulting in sedative, anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant effects.

Complications of Long-Term Use

Healthcare professionals recommend prescribing benzodiazepines at the lowest effective dose and for the shortest duration necessary—ideally for severe anxiety or insomnia rather than mild anxiety. Limiting their use to 2 to 4 weeks can help minimize the risks of tolerance and dependency. Prolonged use often leads to dose escalation, which can begin within just a few weeks of treatment.

While physical dependence, tolerance, and withdrawal symptoms may occur with long-term use, it is crucial to distinguish these conditions from addiction. Addiction is characterized by continued substance use despite experiencing negative consequences. Prolonged use of benzodiazepines can lead to notable changes in brain chemistry, such as down-regulation of GABA neuroreceptors and reduced receptor sensitivity. Furthermore, extended use may exacerbate issues like anxiety, insomnia, and agitation.

Individuals who have used benzodiazepines for more than 2 to 4 weeks may experience withdrawal symptoms if they stop taking the medication abruptly, which can be quite severe in the USA. According to the American Psychiatric Association, between 40% to 80% of patients may face withdrawal symptoms within 24 hours to several days after cessation. For those with psychological dependence, additional support may be necessary, including counseling or therapy, as well as non-addictive anti-anxiety medications like buspirone or certain antidepressants.