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Most Common Benzodiazepines and Signs of Abuse
Reviewed by: Ryan Kelley, NREMT
Benzodiazepines make up a class of central nervous system (CNS) depressants that work by enhancing the effects of the neurotransmitter gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter that effectively slows nerve impulses throughout the body and results in increased feelings of relaxation and calmness. They produce sedation and relieve muscle spasms.
Benzodiazepines have been used for decades to treat anxiety and panic disorder, sleep disturbances related to stress and anxiety, and even some seizure disorders. They are sometimes referred to as "benzos," "downers," "nerve pills," or "tranks" (short for tranquilizers).1,2
These medications work very well for short-term use, with a physician's supervision; however, they are very habit-forming, and the body can easily become dependent on them. Without appropriate medical guidance, a person can quickly become addicted to these medications.
How Are Benzodiazepines Abused?
The Drug Enforcement Administration (DEA) lists benzodiazepines as Schedule IV drugs, meaning they have some potential for abuse, but they also have important medical uses.1 Benzodiazepines are common in cases of polydrug abuse, as they can enhance the effects of other drugs, especially alcohol and opioids.3 Sometimes, people struggling with cocaine addiction take benzodiazepines to reduce the anxious and excited effects of cocaine use.3
According to the National Survey for Drug Use and Health (NSDUH), in 2018, 5.4 million Americans ages 12 and older (2% of the general U.S. population) reported nonmedical use of benzodiazepines in the past year.
Benzodiazepines may help with short-term conditions like anxiety and sleep disorders, which can become more intense with age. Benzodiazepines are widely prescribed in the elderly, despite being associated with impaired cognition and increasing the risk of falls and associated injuries.3 They have also been associated with an increased risk of Alzheimer disease in older people.3
Studies suggest that benzodiazepines affect memory, attention and the ability to concentrate, as well as problems in psychomotor function and learning, although the severity and type of cognitive impairment is depends on the type and dosage.3 Drivers who use benzodiazepines are twice as likely to be involved in a motor vehicle crash vs. an unimpaired driver.4
Despite their risks, benzodiazepines are still among the most commonly prescribed drugs in the world, especially in the United States.
Most Common Benzodiazepines
There are many types of benzodiazepines that have been produced by pharmaceutical companies, but currently, about 15 are approved for use in the United States. Below are the five most commonly found benzodiazepines and their uses:
Xanax (alprazolam): In 2017, there were 45 million prescriptions dispensed for alprazolam.1 This medication a short-acting benzodiazepine used to help people struggling with anxiety disorders, panic attacks, and depression with concurrent anxiety. A newer version of Xanax, called Xanax XR, is an extended-release benzodiazepine designed to work for much of the day.
Klonopin (clonazepam): There were 29.2 million prescriptions dispensed for clonazepam in 2017.1 This medication's generic name is clonazepam, and it is a short-acting medication used to treat a variety of conditions, including anxiety, panic attacks, seizures, and some types of epilepsy. For seizure disorders, this medication is prescribed regularly, but when used to treat anxiety conditions, it is typically prescribed "as-needed."
Ativan (lorazepam): In 2017, there were 26.4 million lorazepam prescriptions dispensed.1 Lorazepam is a common short-acting, short-term treatment for anxiety disorders, including anxiety associated with depression.
Valium (diazepam): In 2017, there were 12.6 million prescriptions dispensed for diazepam1—a long-acting benzodiazepine that has been famous for decades. It's not frequently prescribed to treat anxiety and panic disorders these days, but because it affects the brain for a long period of time, Valium is often prescribed to treat delirium tremens and seizures associated with alcohol withdrawal. It's also sometimes used to sedate someone who's suffering from amphetamine-induced psychosis.3
Restoril (temazepam): There were 7 million prescriptions dispensed for temazepam in 2017.1 Temazepam is a short-acting benzodiazepine indicated for the short-term treatment of insomnia.
In a review of the abuse potential of common benzodiazepines, Diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan) had the highest subjective ratings among drug abusers rating the high achieved.5 Alprazolam (Xanax) and clonazepam (Klonopin) are the two benzodiazepines associated with the most abuse-related emergency room visits.5
Individuals with a history of alcohol abuse or dependence and antisocial personality disorder are at a particularly elevated risk of abusing benzodiazepines.5 Benzodiazepines are predominantly abused by non-Hispanic whites and young adults ages 18 to 35 years comprise the largest portion of benzodiazepine abusers.5
Benzodiazepine Intoxication and Side Effects
When a person becomes addicted to benzodiazepines, it is typically due to the relaxing euphoria, or high, associated with ingesting large quantities of this medication. Sedatives are generally very habit-forming. Those who take benzodiazepines, whether as prescribed or for nonmedical reasons, can experience various side effects. However, people who struggle with benzodiazepine abuse or addiction are more likely to experience side effects, especially at higher doses.
Side effects associated with benzodiazepine intoxication include:6,7
Repetitive, uncontrolled eye movement.
Drowsiness or sleepiness.
Difficulty concentrating.
Muscle weakness.
At high doses, benzodiazepines can produce side effects like:6,7
Slowed reflexes.
Slowed breathing.
Lowered blood pressure.
Mood swings or irritability.
Erratic, unpredictable behavior.
Aggression or hostility.
Stupor or coma.
The most common withdrawal symptoms associated with benzodiazepines involve rebound effects. Because benzodiazepine drugs reduce the uptake of the GABA neurotransmitter, when that effect stops, the brain begins firing rapidly again. People who stop taking benzodiazepines, either as prescribed or in an attempt to overcome an addiction, typically experience rebound insomnia, anxiety, and panic attacks. Some people may develop a benzodiazepine withdrawal syndrome, which can include dangerous seizures.
Medical Detox and Complete Rehabilitation
People who struggle with benzodiazepine abuse and addiction, whether the addiction is to benzodiazepines alone or as part of a pattern of polydrug abuse, need professional help. If a person attempts to withdraw from benzodiazepines without medical oversight, they could experience life-threatening withdrawal symptoms. They are also more likely to relapse without social and medical support, and that can also be physically dangerous.
Diversion Control Division; United States Drug Enforcement Administration. (2019). Benzodiazepines.
U.S. Drug Enforcement Administration. (2017). Drugs of Abuse: Benzodiazepines.
Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
Hetland, A., & Carr, D. B. (2014). Medications and Impaired Driving. Annals of Pharmacotherapy, 48(4), 494–506.
Schmitz, A. (2016). Benzodiazepine use, misuse, and abuse: A review. Mental Health Clinician, 6(3), 120–126.
National Institute on Drug Abuse. (2018). Drug Facts: Prescription CNS Depressants.
Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
Ryan Kelley, NREMT
Medical Editor, American Addiction Centers
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More
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