Benzodiazepine - Overview

Overview

Benzodiazepines are widely prescribed in the treatment of anxiety disordersA group of mental disorders or conditions characterized in part by extreme restlessness, uncontrollable feelings of fear, excessive worrying, and panic attacks., sleep disorders, and seizure conditions. They calm down users by acting on the brain to lower anxiety levels, relax muscles, and bring on sleep. Benzodiazepines were first used in the late 1950s. By the 1960s, physicians were regularly prescribing them to patients in place of barbiturates. Barbiturates, another class of depressants, can slow the breathing center of the brain to dangerously low levels. Benzodiazepines have less of an effect on breathing than barbiturates and are therefore considered safer. In addition, benzodiazepines are less likely to lead to death in cases of overdose.

Official Drug Name: Alprazolam (al-PRAZZ-oh-lam; Xanax), chlordiazepoxide (klor-dye-az-uh-POKS-ide; Librium), clonazepam (kloh-NAZZuh-pam; Klonopin), clorazepate (klor-AZZ-uh-pate; Tranxene), diazepam (dye-AZZ-uh-pam; Valium), flurazepam (flor-AZZ-uh-pam; Dalmane), flunitrazepam (Rohypnol), halazepam (huh-LAZZ-uh-pam; Paxipam), lorazepam (lorr-AZZ-uh-pam; Ativan), midazolam (Versed), oxazepam (oks-AZZ-uh-pam; Serax), prazepam (PRAZZ-uh-pam; Centrax), quazepam (KWAY-zuh-pam; Doral), temazepam (tuh-MAZZ-uh-pam; Restoril), triazolam (try-AY-zoe-lam; Halcion)

Also Known As: Benzos, tranks, downers

Drug Classifications: Schedule IV, except for flunitrazepam (Rohypnol), which is a Schedule III drug; depressant

The likelihood of addiction among benzodiazepine users did not become an issue until several years after their introduction. When taken for a limited amount of time in doctor-prescribed doses, benzodiazepines are generally quite safe. Problems develop when they are taken for more than several months or in larger-thanrecommended doses. Psychological and physical dependence on benzodiazepines can actually occur within a matter of weeks. It has also been reported that benzodiazepine abusers usually combine their "benzos" with other drugs or alcohol. These combinations can lead to very serious physical consequences, including slowed breathing, coma, and even death.

A variety of health conditions can lead to a coma, including head trauma, drinking too much alcohol, and a drug overdose, among other things. A coma is a state of unconsciousness from which a person cannot be awakened by noise or other stimuli.
A variety of health conditions can lead to a coma, including head trauma, drinking too much alcohol, and a drug overdose, among other things. A coma is a state of unconsciousness from which a person cannot be awakened by noise or other stimuli. © Mike Laye/Corbis.

About fifty different kinds of benzodiazepines were being used throughout the world in 2005. However, only fifteen of these have been approved for use in the United States by the Food and Drug Administration (FDA). According to The Pill Book, four of the top seventy-five prescriptions written by U.S. doctors in 2003 were for benzodiazepines:

  • alprazolam (Xanax) ranked 12th
  • lorazepam (Ativan) ranked 32nd
  • clonazepam (Klonopin) ranked 52nd
  • diazepam (Valium) ranked 68th

Of these benzodiazepines, alprazolam was the most frequently abused in the United States in the early 2000s. This likely occurs because it acts so quickly—within twenty to thirty minutes. As Lance P. Longo and Brian Johnson, writing in American Family Physician, put it, "drugs that work immediately tend to be addictive."

Drug companies classify benzodiazepines according to the length of time it takes for them to begin working. The ultra-short acting benzodiazepines kick in almost immediately and are mainly used in a hospital setting as a form of anesthesia. Two common ultra-short acting benzodiazepines are midazolam (Versed) and triazolam (Halcion). The short-acting benzodiazepines typically begin working in less than half an hour. These are among the most commonly abused drugs and include alprazolam (Xanax) and lorazepam (Ativan). The long-acting benzodiazepines, such as chlordiazepoxide (Librium) and diazepam (Valium), take a longer time to produce effects.

The strongest benzodiazepines, known as high-potency benzodiazepines, include alprazolam, lorazepam, triazolam, and clonazepam. Among the less powerful, or low-potency, benzodiazepines are chlordiazepoxide, clorazepate, diazepam, and flurazepam.

"Mother's Little Helper"

Historically, tranquilizers were not the drug of choice among the biggest drug users of the 1960s. College students, hippies, and concertgoing youths of that decade were more likely to experiment with hallucinogenic drugs. Benzodiazepines and minor tranquilizers were associated more with stay-at-home moms. Their practice of taking Valium—the "little yellow pill"—was widespread in the United States and the United Kingdom during this time. The Rolling Stones recorded a song in 1966 called "Mother's Little Helper" about this trend. As noted on CNN.com, the Stones sang: "Mother needs something today to calm her down / And though she's not really ill, There's a little yellow pill / She goes running for the shelter of a mother's little helper.…"

It is estimated that in the 1970s, as many as 30 million women were taking minor tranquilizers. "In promoting these drugs, the manufacturers portrayed stresses of everyday life as disease states treatable by prescribing their products," explained Andrew Weil and Winifred Rosen in From Chocolate to Morphine. Some advertisements "suggested giving tranquilizers to harried mothers and bored housewives." One particular ad aimed at physicians suggested they carry syringes of injectable diazepam "ready to use, when something must be done to calm the patient in emotional crisis." As Weil pointed out, ads like these always seemed to feature pictures of women as emotionally distressed patients in need of help. Psychiatrists were freely prescribing these minor tranquilizers to women with little regard of their potential for addiction.