Benzodiazepines



The benzodiazepine family of depressants are used therapeutically to produce sedation, induce sleep, relieve anxiety and muscle spasms and to prevent seizures. In general, benzodiazepines act as hypnotics in high doses, as anxiolytics in moderate doses and as sedatives in low doses. Of the drugs marketed in the United States that affect CNS function, benzodiazepines are among the most widely prescribed medications and, unfortunately, are frequently abused. Fifteen members of this group are presently marketed in the United States and an additional twenty are marketed in other countries.

Like the barbiturates, benzodiazepines differ from one another in how fast they take effect and how long the effects last. Shorter acting benzodiazepines, used to manage insomnia, include estazolam (ProSom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril) and triazolam (Halcion).

Benzodiazepines with longer durations of action include alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), halazepam (Paxipam), lorazepam (Ativan), oxazepam (Serax) and prazepam (Centrax). These longer acting drugs are primarily used for the treatment of general anxiety. Midazolam (Versed) is available in the U.S. only in an injectable form for an adjunct to anesthesia. Clonazepam (Klonopin) is recommended for use in the treatment of seizure disorders.

Flunitrazepam (Rohypnol), which produces diazepam-like effects, is becoming increasingly popular among young people as a drug of abuse. The drug is not marketed legally in the United States, but is smuggled in by traffickers.

Benzodiazepines are classified in the CSA as Schedule IV depressants. Repeated use of large doses or, in some cases, daily use of therapeutic doses of benzodiazepines is associated with physical dependence. The withdrawal syndrome is similar to that of alcohol withdrawal and is generally more unpleasant and longer lasting than narcotic withdrawal and frequently requires hospitalization. Abrupt cessation of benzodiazepines is not recommended and tapering-down the dose eliminates many of the unpleasant symptoms.

Given the number of people who are prescribed benzodiazepines, relatively few patients increase their dosage or engage in drug-seeking behavior. However, those individuals who do abuse benzodiazepines often maintain their drug supply by getting prescriptions from several doctors, forging prescriptions or buying diverted pharmaceutical products on the illicit market. Abuse if frequently associated with adolescents and young adults who take benzodiazepines to obtain a "high." This intoxicated state results in reduced inhibition and impaired judgement. Concurrent use of alcohol or other depressants with benzodiazepines can be life-threatening. Abuse of benzodiazepines is particularly high among heroin and cocaine abusers. Approximately 50 percent of people entering treatment for narcotic or cocaine addiction also report abusing benzodiazepines.