Benzodiazepine Dependance and Addiction are on the Rise

Benzodiazepines – which include drugs such as alprazolam (Xanax®), chlordiazepoxide (Librium®), diazepam (Valium®), lorzepam (Ativan®), and clonazepam (Klonopin®) – are the most common medications used to treat anxiety disorders as well as insomnia. While these medications tend to be very effective and have clinically appropriate short and long-term uses in clinical practice, they have significant side effects (including memory impairment and cognitive decline, fall-risk, disinhibition, and depression1) and also present a significant risk for dependance and addiction.

Use of benzodiazepines has been on the rise in recent years – both legal and illicit use have climbed substantially. A 2019 paper2 found that the annual prevalence of benzodiazepine use was 12.6% - around 30.6 million adults. Of these, 25.3 million reported use as-prescribed by their clinician, while 5.3 million reported misuse. The most common form of misuse was use without a prescription (illicit use), which was most prevalent in young adults. Also common was taking more than prescribed. To underscore the dangers of these statistics, the Centers for Disease Control (CDC) reported that in 20203, emergency department visits for benzodiazepine overdose increased by 23.7% with deaths from legal use increasing by 21.8% and from illegal use by an alarming 519.6%.

While not directly related, a paper published just last month4 seeks to define the problem of persistent benzodiazepine dependance – which is obviously a growing concern given the prevalence of use. In this paper, the authors describe the substantial challenge of discontinuation of benzodiazepines – reporting that up to 86% of those who successfully taper off of these medications resume them within 2 years. The authors further describe a cycle of “significant psychiatric instability and functional decline” related to long-term use and attempts at discontinuation.

Given that few good medical alternatives exist for serious anxiety disorders, the difficulty in treatment discontinuation, the high rates of abuse and overdose, greater caution clearly needs to be taken with this class of medications. While some may point out the great benefits of non-pharmacological interventions such as Cognitive Behavioral Therapy, these treatments are only as effective as a regular practice – much like one only benefits from the gym if you go and exercise. Greater consideration needs to be given overall to creating viable alternative for those with anxiety disorders so that we can both relieve current and prevent future suffering.

 

References:

  1. Longo LP, Johnson B. Addiction: Part I. Benzodiazepines—Side Effects, Abuse Risk and Alternatives. Am Fam Physician. 2000;61(7):2121-2128.
  2. Maust DT, Lin LA, Blow FC. Benzodiazepine Use and Misuse Among Adults in the United States. Psychiatr Serv Wash DC. 2019;70(2):97-106. doi:10.1176/appi.ps.201800321
  3. Dependence on benzodiazepines lead physicians to coin new diagnosis: The sedatives are considered an underrecognized contributor to public health crisis of drug overdoses. ScienceDaily. Accessed June 15, 2022. https://www.sciencedaily.com/releases/2022/06/220603124649.htm
  4. Peng L, Meeks TW, Blazes CK. Complex Persistent Benzodiazepine Dependence—When Benzodiazepine Deprescribing Goes Awry. JAMA Psychiatry. Published online May 18, 2022. doi:10.1001/jamapsychiatry.2022.1150