The Benzo Problem – Elemental

TTessa, age 32, who declined to share her last name for anonymity, is one of many who have gotten addicted to benzodiazepines having them prescribed. Her first benzo prescription was Ativan, to prevent seizures while withdrawing from alcohol at age 24. At the time, she was also suffering from anxiety and panic attacks, which showed no signs of stopping. At 26, she was prescribed Klonopin to take “as needed” and given a small amount of 10 pills per month. When she moved a year later, her new doctor gave her a prescription for 30 pills per month.

“I was open with my psychiatrist about my addiction history, and she advised me to only take benzos when I had a bad panic attack or difficulty sleeping for multiple nights,” Tessa recalls. “They worked so well. The panic was replaced with a sense of calm and ease, so as soon as I got prescribed 30 per month, I took them everyday because they made me feel like I was floating through life, breezy and weightless.”

On top of her Klonopin prescription, she was also being prescribed Temazepam, another benzodiazepine, primarily used to treat insomnia. She was receiving 90 benzo pills total per month: 30 Klonopin and 60 Temazepam.

Tessa developed a physical dependence on the benzos, and her tolerance grew. Soon, her use turned into an addiction. “I began taking multiple Klonopin or Temazepam pills at a time to chase that same numbing effect,” she says. She became numb not only to her anxiety, but also to external factors. She withdrew from friends and stopped caring about her passions.

“[Benzos] can become an answer to every question. They can become what to do when you’re anxious, but they can slip into what to do when you can’t sleep, what to do when you have a fight, or what to do when you’re bored.”

“I also stopped caring about being sober, then started doing heroin along with the benzos,” she says. “When I was 29, benzos were a full-blown obsession and ruled my life.” Once she ran out of pills, she took to the streets to try to buy more pills, as well as opiates.

“I knew this was a very dangerous combination, as both heroin and benzos are central nervous system depressants, but I didn’t care,” she says.

Taking more pills than prescribed on a regular basis is one of the telltale signs of a forming benzo addiction. Some other behaviors that can be marks of addiction, according to Lembke, are “using [benzos] for indications other than prescribed, hoarding and bingeing, going to multiple doctors to try to find the same or similar prescriptions, and spending a lot of time thinking about using the drug.”

Avery adds, “[Benzos] can become an answer to every question. They can become what to do when you’re anxious, but they can slip into what to do when you can’t sleep, what to do when you have a fight, or what to do when you’re bored. They can fill a lot of roles beyond what were initially prescribed for.”

WWith all of this known, is there really a “safe” way to prescribe or take benzos?

Both Lembke and Avery agree that they’re best-suited for either short-term acute use or intermittent use.

“I think [benzos] are a great tool when used very short term for emergent situations or very, very intermittently, for example, a once or twice a month when you have a panic attack, if that’s your problem, or if you have a flying phobia and you use it when you get on an airplane,” says Lembke.

Avery seconds the notion of intermittent use for panic attacks or phobias, and also says a good use for a benzo is to help with a patient’s initial treatment process, when they are first starting cognitive behavioral therapy (CBT) and/or waiting for a long-term antidepressant to kick in.

“We really think the treatment for anxiety is CBT or antidepressants, not these benzos, which are sort of a short term band-aid,” he states. As time goes on, you should ideally be taking less benzodiazepines, not more, as your anxiety and other symptoms should ideally be improving through other forms of treatment. “If you find yourself taking the benzodiazepines every day, then I think you have to really rethink your treatment plan,” he says.

Aside from ideal dosing for safety, there’s also the issue of safety when prescribing other medications along with benzos, specifically opiates.

Lembke believes that polypharmacy (taking multiple medications at once) is a main cause of the uptick in benzo overdose deaths. She says, “A lot of polypharmacy patients who are taking benzos are also taking other sedatives, sometimes prescribed by other doctors who aren’t aware of what the patient is taking. Then, the cumulative effect of taking them together is really what drives the overdose risk, even when taken as prescribed.”

This is particularly true with opiates being prescribed in conjunction with benzos. According to Avery, many people who overdose on benzos often have opiates in their system, and vice versa. Of course, there’s also the issue of accidentally taking benzos laced with opiates, which is becoming more of an issue, when buying them illicitly. “As people get cut off from their benzos from doctors, they go to purchase them on the street or from drug dealers, and often you can get contaminated products from that setting,” he says. Many of these illicit pills are laced with opiates, whether the buyer realizes it or not. As you can imagine, Avery’s advice is to not buy benzos off the street.

IfIf you’re reading this and feeling nervous about your own benzo use, or maybe a loved one’s benzo use, be sure to voice your concerns to a doctor and discuss if the way that you use benzos is safe, or if the treatment plan should be altered. You should never stop a drug cold turkey, especially a benzo, as withdrawals can be severe and life threatening. You may experience hallucinations, seizures, and even suicidal thoughts and/or actions. If you and your doctor should decide to discontinue the benzo, a tapering plan will be enacted, and you’ll need to closely monitor symptoms.

As benzo awareness grows, the hope is that doctors across the board will stop overprescribing, will be more conscious of polypharmacy, and will educate patients about the risks of the medication, as well as information on how to safely take it.

There has already been a shift, at least in med school students. “Many medical schools now are trying to incorporate an addiction treatment curriculum and a safe prescribing curriculum,” says Lembke. Stanford has a new addiction medicine curriculum, for example.

“There’s definitely been a shift. There’s a lot more interest and enthusiasm from medical students to learn about addiction, so it’s really nice to see,” she adds. “That’s the silver lining of the epidemic.”

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