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Benzodiazepines: our other prescription drug epidemic
I got the call each dependence specialist fears: A patient of mine almost gone too far. He had a long history of enslavement, beginning with narcotic agony pills in his youngsters after a games injury and advancing to heroin by his mid 20s. He had been in recuperation for a considerable length of time.
“Was it heroin?” I asked the specialist, who was calling from the crisis office.
Benzodiazepines, a class of drugs frequently used to treat anxiety and insomnia, are abbreviated as “benzos.” Ativan, Klonopin, Valium, and Xanax are among the roughly a dozen varieties. Most people are familiar with them. They are used by more people than you might think (three benzodiazepines rank among the top ten psychotropic medications prescribed in the United States). However, not many people are aware of the number of addicts and deaths associated with them.
We need to pay more attention to America’s other prescription drug problem, the hidden epidemic of benzodiazepine abuse, as my colleagues Jennifer Papac and Keith Humphreys and I write in this week’s New England Journal of Medicine.
The number of adult prescriptions for benzodiazepines rose by 67% from 8.1 million in 1996 to 13.5 million in 2013. Benzodiazepine prescribing continues to rise, in contrast to opioid prescribing, which peaked in 2012 and has since decreased by nearly 20%. When benzodiazepines and opioids are combined, the risk of overdose death nearly quadruples; however, co-prescribing rates of benzodiazepines and opioids nearly doubled between 2001 and 2013. Between 1999 and 2015, the number of benzodiazepine overdose deaths increased by more than sevenfold.
A few days later, I called my patient to talk to her. He was doing much better and was content to be alive. I asked him specifically what he had taken and how he had obtained it. He wasn’t getting benzodiazepines from a doctor’s prescription, as far as I could tell. He didn’t have a prescription for benzodiazepines, as I frequently check the database for prescription drugs. Did he buy Z-bars on the street, which are 2-milligram bars of prescription Xanax that are popular with teens and young adults?
His response was unexpected and frightening.
He got the benzodiazepine that nearly killed him, clonazolam, from a website. The generic names for Klonopin and Xanax, clonazepam and alprazolam, were combined to create the name. Clonazolam is a benzodiazepine with a lot of potency that is made in labs all over the world, including in the United States. It is sold as a “research chemical” and can be sent almost anywhere. Because of its potency, it must be dosed using a high-precision scale at the microgram level, or millionths of a gram.
My patient knew that clonazolam is intense, yet didn’t understand exactly the way in which strong it is. Since he didn’t have a precise scale, he decided to measure the tiniest amount to be safe.
He informed me, “The amount I took was insufficient to cover a fourth of my pinkie fingernail.” I believed I was safe. He was fortunate to be alive when he woke up in the hospital, hours later.
Profoundly powerful medications like these originator benzodiazepines are a developing pattern among those looking for another high, filled to some degree by specialists overprescribing benzodiazepines without valuing their habit-forming potential. Overprescribing benzodiazepines may herald the beginning of a new era of illicit and deadly benzodiazepines, just as overprescribing opioids contributed to heroin use, illicit fentanyl, and related deaths.
Benzodiazepines function admirably to ease tension or a sleeping disorder when utilized discontinuously and for under a month at a time. They can worsen anxiety and insomnia if taken regularly for an extended period of time. The majority of doctors don’t know how addictive benzodiazepines can be for some people and prescribe them long-term without safety monitoring, such as checking the prescription drug monitoring database, because they don’t know better. Long-term use of benzodiazepines can cause cognitive decline, accidental injuries, and falls in addition to addiction and death.
For insomnia and anxiety, alternatives to benzodiazepines are available. These include long-term medications like selective serotonin reuptake inhibitors and behavioral interventions.
Related: At their own peril, many Americans continue to misuse prescription drugs. Physicians can help address a portion of this public health crisis by using more responsible prescribing methods. However, the public can also assist. Be wary of accepting a prescription for a benzodiazepine, including Ambien, a close relative of benzodiazepines that is also addictive and potentially lethal, if you are experiencing anxiety or insomnia and visit your doctor.
If you take benzodiazepines every day, ask your doctor if they can help you stop taking them. Because abruptly stopping a benzodiazepine can lead to life-threatening withdrawal, it’s important to take your time. If you are a parent and notice a precision laboratory scale in your child’s bedroom or some enigmatic FedEx packages, you should act quickly to get worried.
