Jessica Williams

Health 1050
Section 3

Benzodiazepine
Benzos, as they are more commonly called, are one of the most commonly
prescribed medications in the United States. Currently there are over 2,000 kinds of
Benzodiazepines on the market today. But what do they do? In short,
Benzodiazepine are a psychoactive drug known as a tranquilizer. Our brains
naturally have a way to calm us down. When we become anxious, our brain is
considered abnormally excited or over-active. Our brains will send a signal to slow
the activity of the neurons which reduces the symptoms that result from our brains
from overworking. This is used to treat a number of legitimate medical concerns,
such as anxiety, insomnia, seizure control, inducing amnesia, and lessening the
effect of alcohol withdrawal. They possess sedative, hypnotic, anti-anxiety,
anticonvulsant, and muscle relaxant properties. Benzos bind to a GABA
neurotransmitter to produce an enhanced calming effect. GABA is a channel
receptor, which means it changes shape to allow an ion to pass through it and
because it mainly allows negative ions to pass, it reduces excitability. It is one of the
most common kinds of neural receptors and it is estimated that 40% of all the
synapses in the human brain work with GABA and therefore have receptors for it.
GABA resides in our brain cells. Each cell has up to 200,000 synapses and each
synapse will have an estimated 40 trillion GABA transmitters.
Each drug is categorized by how long the effects last and has a different halflife (how long the drug remains in your body). It varies greatly depending on how it
is prescribed and can take effect anywhere from 20 minutes to an hour. There are

ultra-short acting drugs such as Versed and Halcion. Short-acting drugs known as
Xanax and Ativan. And then there are long-acting drugs like Valium and Librium.
There is no age limit for anxiety but the most common ages that people admitted to
first using Benzos were between the ages of twelve and twenty and most
surprisingly by males more than females. There are two ways to take Benzos. The
most common is small tablets but you can also use an Intravenous Injection (IV) or
pumping it through a mask orally. They can be used to induce Intravenous
Conscious sedation, also known as Deep Conscious Sedation to be used for medical
and dental surgeries and are at times used with anesthesia to calm a patient before
and after surgery.
Though they are used for legitimate medical reasons, Benzos are suggest for
short time use. Taken carelessly can lead to abuse, addiction and dependence.
People who abuse Benzos are more likely to have severe chronic affects including
memory loss, loss of cognitive function, and ataxia. Although the drug itself is not
generally fatal on its own, mixing it with other drugs and alcohol can lead to tragic
consequences such as death or a permanent comatose state.
But why they addictive? You would assume that because it is a downer, you
wouldnt get any positive effects from it. The desirable sensations that make a lot of
illegal drugs addictive occur when dopamine levels in the brain abruptly surge.
Benzos weaken the effect of a group of cells called inhibitory interneurons. These
neurons normally help prevent excessive dopamine levels by decreasing the firing
rate of specific neurons. When Benzodiazepine limit those restraining influences, it
causes a release of more dopamine.

Chronic alcohol use creates an insensitivity to the GABA transmitter, which is

why you build a tolerance to it. Glutamate is one of the major excitatory amino
acids and alcohol obstructs the neurotransmitter. Only the constant presence of
ethanol preserves homeostasis. Abruptly stopping results in over activity of the
central nervous system, shaky hands, sweating, nausea, vomiting, headaches,
insomnia and seizures. Benzos such as Librium help the symptoms that occur during
the withdrawal process. It acts like alcohol, which helps your body stay in
homeostasis without the chance of relapse.
Benzodiazepine has been known to be a very effective anti-convulsant, used
for patients with epilepsy and other drug related withdrawals. Doctors will proscribe
aggressively for people who are in Status Epilepticus a seizure that lasts for longer
than five minutes or more than one seizure in five minute period. Antivan, Valium
and Versed are the most effective.
The withdrawal process is nasty. It is one of three known drugs that need a
step down in order to ween off of. Abruptly quitting can lead to seizures and death.
The process starts after taking the last dose and the immediate symptoms kick in.
Users have been known to experience an increased irritability and/or emotional
outbursts, an inability to concentrate or perform simples tasks and/or memory
problems, body aches and pains and/or stiffness/soreness, sleep disturbance,
anxiety or panic attacks, suicidal thoughts, seizures and possibly death (usually only
for improper withdrawal process and severe addiction). The next step is an Acute
Phase and can last anywhere from seven to ninety days. The lengths vary on the
type of medication you take and usually is never done in the hospital. It involves a
weaning process. The last stage is called PAWS (Post-Acute Withdrawal Symptoms)

and can last anywhere from ninety days to two years. It involves generally mild
symptoms that go away over a period of time.
For most cases, this process is done at home unless it is a severe life or death
case. For others, there is an option called Rapid Benzodiazepine Detoxification
(RBD). It is an outpatient program that uses an accelerated detoxification method
that can complete the acute withdrawal process in about eight days. They stop their
Benzo use and starts on Flumazenil. It provides relief for the withdrawal symptoms
and at the same time removes Benzos from the patients body. All patients must
have a support person who will be with them throughout the detox. The downside of
this is that the treatment costs approximately $7,500. This does not include
transportation, lodging or meals and no type of insurance is accepted. All the
expenses are the responsibility of the patient and will be collected at time of
service. Most patients are comfortable but every procedure has its risk. You should
not use if you have been given Benzos for the control of a life threatening condition
or if you are experiencing side effects due to an overdose of medicine used to treat
depression. You might not even be eligible for this program. They will take into
consideration the reason you began using, which will also help predict how east it
will be to get you off the drugs and stay off them. Why does it work? Flumazenil is a
GABA receptor antagonist. It attaches itself to the receptors and binds so tightly
that it actually displaces any other benzodiazepines. It stabilizes the receptors so
that patients relief from the withdrawal symptoms. Some clinicians believe that the
Flumazenil actually re-sets the GABA receptors, back to a normal state, so that after
the therapy is completed, most patients seem to lose their desire for any
benzodiazepines. Although Flumazenil is a specific antidote, its use is controversial
and is argued that the risks usually outweigh any possible benefit. In long-term

users, flumazenil may possibly speed up the withdrawal process and seizures. In
patients taking Benzos for a medical condition, flumazenil may result in the
worsening of the condition.
What happens during a Benzodiazepine overdose? As with any overdose, the
first step is to evaluate the patient's airway, breathing, and circulation and address
any of these rapidly if needed. The basis of treatment in these types of overdose is
good supportive care and monitoring. The combination of Benzos and opioid
painkillers can produce high levels of respiratory depression. In particular, the
combination of alprazolam (Ativan) with opioids may be fatal. Benzodiazepine
toxicity can result from overdose or from continual abuse. It also often occurs with
the use of other substances. The treatment for toxicity poisoning is a very rapid
process. Patients can be discharged if they dont exhibit symptoms for at least 6
hours post ingestion. Those with mild toxicity are observed in the emergency
department until they recover. Like any patients that do intentional overdoses, they
require psychiatric evaluation before discharge. Benzos can have toxic effects over
long term use. It is possible to get propylene glycol poisoning from the diluent used
in making these drugs. Although rare, this may result in hypotension, cardiac
dysrhythmias, a dangerous lactic acid build up called lactic acidosis, seizures, or
coma. The symptoms of a Benzodiazepine overdose are dizziness, confusion,
drowsiness, blurred vison, unresponsiveness, anxiety and agitation. There can also
be repetitive and uncontrolled eye movements, hallucinations, slurred speech,
ataxia, low muscle tone, muscle weakness, altered mental status, amnesia,
respiratory depression, and hypotension.
According to numerous studies, in adults over 65, those who used
benzodiazepines were fifty percent more likely to develop dementia over a 15-year

period. It was true even when taking into account other factors that might increase
dementia risk, such as age, gender and diabetes. The study also suggested that
those who take these medications are at a higher risk for certain cancers and are
more likely to suffer long term cognitive problems. The elderly have a much more
difficult time eliminating Benzos and similar drugs from their bloodstreams,
especially while on multiple medications. Over time, these drugs can accumulate in
your body which increases the risk of an accidental overdose. They have been
linked to the serious increased risk of getting into a car accidents. Common side
effects are unsteady gait, falling, dizziness, hip fractures, impairment of thinking,
and memory loss. Mental illness is devastating. It takes a toll on the healthiest of
families and can destroy lifelong friendships.
What can help you during and after the withdrawal process? Two of the most
powerful weapons to combat anxiety are mindfulness meditation and exercise.
Learn how to combat these feelings naturally instead of relying on medication to fix
your problems. Wear loose-fitting, comfortable clothing. The body and brain need to
relearn how to work together and accomplish tasks. Start with small things like
taking short walks, painting nails, drawing, journaling, learning how to knit, singing
and/or playing catch. . Few things are harder in life than watching someone you love
struggle with anxiety, panic attacks or depression, and to not have anything within
your power that can change things for them. Oftentimes you cannot change your
circumstances. You can, however, change your response to them. I encourage you
to be balanced in your life. Don't ignore your body's warning signs that something
needs to change. Sometimes people are so busy taking care of everybody else that
they lose sight of themselves. There are times when a prescription drug may help
restore balance to your body. But it's unclear whether it is the drug providing

benefits, or the unbelievable power of your mind that is convinced it is going to

work.

Works Cited
Health Grove. "Benzodiazepines." Abuse Rates. SAMSHA, 2012. Web. 01 Nov. 2015.

<http://substance-abuse-rates.healthgrove.com/l/14/Benzodiazepines>.
Ashton, C. Heather, DM. "History of Benzodiazepines: What the Textbooks May Not
Tell You." Psychiatric Medication Awareness Group. 3rd Annual Benzodiazepine
Conference, 12 Oct. 2005. Web. 01 Nov. 2015.
<http://www.psychmedaware.org/HistoryBenzodiazepines.html>.
Silverman, Michael D. Dr. "Oral Sedation Dentistry." Which Oral Sedation Medication
Is Right for You? Dear Doctor, Inc., 1 Feb. 2009. Web. 01 Nov. 2015.
<http://www.deardoctor.com/articles/oral-sedation-dentistry/page3.php>.
Mangan, Caetlin. "Benzo Withdrawal: The Ultimate Guide to Symptom Relief." Benzo
Withdrawal: The Ultimate Guide to Symptom Relief. Discovery Place, n.d. Web. 01
Nov. 2015.
<https://www.discoveryplace.info/benzo-withdrawal-ultimate-guidesymptom-relief>.
TCI. "Rapid Benzodiazepine Detoxification FAQ." Rapid Benzodiazepine
Detoxification FAQ. The Coleman Institute, n.d. Web. 01 Nov. 2015.
<http://www.thecolemaninstitute.com/rapid-benzodiazepine-detoxificationfaq>.
"Addictions and Recovery: Tranquilizers and Benzos." Addictions and Recovery. N.p.,
02 June 2015. Web. 01 Nov. 2015.
<http://www.addictionsandrecovery.org/benzodiazepine.htm>.
Goldberg, Joseph, MD. "Benzodiazepine Abuse." WebMD. WebMD, 22 Apr. 2014.
Web. 01 Nov. 2015.
<http://www.webmd.com/mental-health/addiction/benzodiazepine-abuse>.
NIDA. "Well-Known Mechanism Underlies Benzodiazepines' Addictive
Properties." NIDA. National Institute on Drug Abuse, 19 Apr. 2012. Web. 01 Nov.
2015.
<https://www.drugabuse.gov/news-events/nida-notes/2012/04/well-knownmechanism-underlies-benzodiazepines-addictive-properties>.
Pomerantz, Jay, MD. "Risk Versus Benefit of Benzodiazepines." Risk Versus Benefit
of Benzodiazepines. Psychiatric Times, 01 Aug. 2007. Web. 01 Nov. 2015.
<http://www.psychiatrictimes.com/articles/risk-versus-benefitbenzodiazepines>.
Hoffman, Robert S., MD, and Gerald L. Weinhouse, MD. "Management of Moderate
and Severe Alcohol Withdrawal Syndromes." UpToDate. N.p., 10 June 2015. Web. 01
Nov. 2015.

<http://www.uptodate.com/contents/management-of-moderate-and-severealcohol-withdrawal-syndromes>.