What are benzos?

Benzodiazepines, commonly known as benzos, are a class of prescription medications designed to slow down brain activity. They may be prescribed to treat everything from anxiety to seizure disorders.

Although benzodiazepines have a recognized medical purpose, they may also be abused, sometimes in tandem with highly addictive opioids. Even on their own, benzos have addictive potential. Learn more about benzodiazepines and their potential risks below.

What are benzodiazepines?

Benzodiazepine is the umbrella term for a class of medications with a sedative effect. They may also be referred to as tranquilizers. Some familiar types of benzos you may have heard of include:

• Xanax® (alprazolam)
• Valium® (Diazepam)
• Ativan® (lorazepam)
• Klonipin® (Clonazepam) 

Benzos encourage the release of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain. This neurotransmitter slows nervous system activity, resulting in sedative-like or even hypnotic effects. Benzos also temporarily block new memory formation, having an amnestic effect.

Benzodiazepine side effects include:

• Behavioral changes
• Confusion
• Coordination
• Delirium
• Depression
• Dizziness
• Drowsiness
• Increased anxiety
• Impaired coordination
• Memory problems

Benzodiazepines are commonly prescribed and widely used. Benzos may be prescribed to treat:

• Insomnia
• Anxiety
• Panic disorders
• Muscle spasms
• Seizures

Although benzos have proven medical merits, they unfortunately also pose a risk for misuse.

Benzodiazepines addiction potential

Benzodiazepine addiction is classified as a "hypnotic, sedative, or anxiolytic use disorder" in the Diagnostic and Statistical Manual of Mental Disorders, the go-to guide for clinically defining mental health disorders.

When discussing medicine misuse, it's always important to distinguish between drug dependency and addiction. A person can be dependent on a drug, meaning the body physically relies on it, without being addicted to it.

When someone has developed drug dependence on benzos, they will likely experience withdrawal symptoms if they stop taking the medication. Symptoms can include:

• Seizures
• Anxiety
• Difficulty concentrating
• Hand tremors
• Headache
• Irritability
• Loss of appetite
• Loss of sex drive
• Nausea
• Pain in the head, neck, face, or eyes
• Palpitations
• Panic attacks
• Sleep disturbances
• Sweating
• Tension
• Tinnitus
• Weight loss

Addiction involves an additional mental component. When people are addicted to a substance, their behavior changes. For example, they may act out of character, undertaking risky behaviors, like stealing, in order to acquire the substance they are addicted to.

Benzodiazepines + opioids

Benzodiazepines should never be mixed with alcohol, cannabis, or opioids. Mixing benzos and opioids can be particularly problematic as both substances slow down the central nervous system. As a result, common effects of opioids, like slowed breathing and heart rate, become even more pronounced.

This can increase the risk of overdose and may even be fatal. In fact, data from 2021 showed that nearly 14% of overdose fatalities related to opioid use also involved benzodiazepines.

Polysubstance use (consuming more than one drug at once) can also enhance addiction potential and generally complicate treatment. For example, Suboxone, which is a gold standard treatment for opioid use disorder (OUD), can't always be taken safely alongside anti-anxiety medications.

Unfortunately, it's not uncommon for people with OUD to struggle with anxiety. A vicious cycle can result, as people turn to opioids to relieve anxiety and then experience withdrawal-related anxiety if they stop taking opioids. The OUD-related anxiety can also leave people seeking relief in other forms—like benzos.

Signs of benzodiazepine misuse

Knowing the signs of possible benzo misuse can help encourage earlier intervention. Some common indicators that a person is misusing benzodiazepine include:

• Craving the medication
• Fixating on when you're allowed to take your next dose
• Feeling reliant on your medication
• Running out of your prescription prematurely
• Taking more of the medication than prescribed or intended, or needing to take more of the medication in order to achieve the same effect
• Taking the medication over a longer period than originally intended
• Experiencing difficulties at home, work, or school—such as difficulty staying awake in class due to benzo-induced drowsiness

If you notice these symptoms, talk to a medical professional as soon as possible.

How to reduce the risk of benzodiazepine misuse

Benzodiazepine misuse can have dangerous consequences. However, that doesn't mean you need to avoid benzos altogether. If a medical professional prescribes benzos for a valid reason, there are steps you can take to reduce the risk of misuse:

• Take any drugs only as prescribed by your physician
• Tell your physician if you are taking any other medications, including supplements
• Follow the doctor's instructions for taking the medicine precisely, in line with the appropriate dose and timing
• Don't change the dosage or take the medication more frequently than prescribed without consulting the doctor first
• Don’t use benzos with other drugs, like opioids or alcohol

Additionally, make sure that any medications are safely locked away to prevent others from accessing them. This protects both you and those around you. Unfortunately, benzo misuse is often enabled by easy access in the homes of a person's friends or family.

If you're worried about potential dependence or misuse issues or have a history of drug misuse, talk to your doctor. They may be able to advise you on steps to minimize the risk. For example, they may lower your dosage or explore alternative treatment options.

Finally, if you are living with addiction, know that there is help available. Reaching out to a trusted loved one or your healthcare provider can be a first step in getting the support you need. Ophelia’s online treatment for OUD is at the forefront of modern care, offering dedicated care teams and personalized support that makes sense for your real life.

We make sure our patients get the medication they need to address opioid misuse and connect them with support for other behavioral and mental health challenges they might be facing. Our mission is to provide comprehensive care, so patients feel empowered about their future.