Health Tips

You may have heard of people addicted to painkillers (or more accurately known as the opioid-based painkillers such as tramadol and morphine). But do you know that people can also get addicted to sleeping pills as well? 

Read on!

Introducing: benzodiazepines

Sleeping pills is a broad term, what we’re alluding to is actually a group of psychotropic medications known as the benzodiazepines. Benzodiazepines are commonly used for reducing anxiety, depression and inducing sleep. Examples of benzodiazepines are:

• Diazepam (Valium®)

• Alprazolam (Xanax®)

• Midazolam (Dormicum®)

• Clonazepam (Klonopin®, Rivotril®)

• Lorazepam (Ativan®)

• Clobazam (Frisium®)

Benzodiazepines generally produce almost immediate effects, and thus doctors usually prescribe them short-term, intermittent, “as-needed” use. Because many of the anxiety disorders wax and wane over time, patients with these disorders often prefer benzodiazepines because these agents can be taken intermittently, when patients feel the need to take them, and most patients can use benzodiazepines judiciously. 

However, just like most of the addictive drugs, benzodiazepines do carry risk of addiction.

How benzodiazepines lead to addiction?

While the complete process is not fully understood, benzodiazepines cause addiction in a way similar to how most addictive drugs and other addictive behaviours, such as playing computer games and smartphones. It came about: through the dopamine reward system.

Benzodiazepines give patients the calming and sedative effect by binding to a group of receptors in the brain, known as the gamma-aminobutyric acid type A (GABA-A) receptors. When benzodiazepines occupy these receptors, inhibitory signals known as GABA are not released to the dopamine neurons. As a result, there will be an increase in dopamine transmission (a process known as disinhibition). In the long run, such a process can keep reinforcing the dopamine reward system that is highly dependent on the intake of benzodiazepine.

Signs and symptoms of benzodiazepine addiction

The following may suggest benzodiazepine addiction or benzodiazepine use disorder:

• Benzodiazepines taken in larger amounts or over a longer period than intended

• Persistent desire or unsuccessful efforts to control benzodiazepine use

• Great deal of time spent obtaining or using benzodiazepines

• Craving to use benzodiazepines

• Recurrent benzodiazepine use resulting in failure to fulfill major role obligations

• Continued benzodiazepine use despite persistent interpersonal problems

• Important activities given up or reduced because of benzodiazepine use

• Recurrent benzodiazepine use in hazardous situations

• Continued benzodiazepine use despite persistent resulting problems

• Evidence of tolerance or withdrawal from benzodiazepine use

Photo by Danilo Alvesd on Unsplash

Patients with a benzodiazepine use disorder may present with a range of severity. Milder cases may have no signs of benzodiazepine use or abnormal medication-taking behaviors only, while patients with greater severity may present with acute intoxication or benzodiazepine withdrawal.

Most addicts prefer short-acting benzodiazepines (e.g. alprazolam and lorazepam) because of their rapid onset of effects. Benzodiazepine addicts also tend to have other substance abuse issues as well, such as alcoholism or heroin, and they may mix multiple benzodiazepines with these substances together for consumption. Such use is highly dangerous, as patients may get an overdose, which can lead to coma, failure in breathing or even death.

Benzodiazepine withdrawal

Abrupt discontinuation of benzodiazepines after regular use at a recommended dose can lead to withdrawal symptoms, such as rebound anxiety and insomnia. In moderate to severe cases, the individual may even show irritability, panic attack, seizure or even psychosis.

If you’re on long-term benzodiazepine treatment, it’s important that you follow your psychiatrist’s instructions properly, especially on gradually cutting down the amount of benzodiazepines you take to avoid withdrawal.

Treatment of benzodiazepine withdrawal

Counterintuitively, the treatment of benzodiazepine withdrawal is another benzodiazepine.

It’s usually a longer-acting one such as diazepam, given intravenously. The dose will be slowly titrated to desired effects. The goal of doing so is to eliminate the withdrawal symptoms without causing coma or failure in breathing. Once the withdrawal symptoms are controlled, the benzodiazepine dose should be reduced gradually over a period of months, until little or no benzodiazepine is required. Flumazenil is the antidote to people who experienced benzodiazepine overdose.

Do not abuse your prescription medications

Benzodiazepine is a prescription medication and it is strictly prescribed by a registered doctor only. It is illegal and dangerous to obtain benzodiazepines without a doctor’s prescription from other sources such as pharmacies or online. Follow the doctor’s and pharmacist’s instructions judiciously on how to take your benzodiazepines. When in doubt, always consult a healthcare professional you trust.

A word from DOC2US

If you have any questions related to benzodiazepine, you can consult our professional doctors and healthcare professionals on DOC2US. DOC2US is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.

Download DOC2US app on Apple App Store, Google Play Store and Huawei App Gallery; or use our web chat at https://web.doc2us.com/

Note: DOC2US is not for medical emergencies. In the event of urgent medical conditions, please call 999.

Disclaimer: As a service to our users and general public, DOC2US provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Specific references have been linked in its relevant part of the article. 

Cover image credit: Photo by Danilo Alvesd on Unsplash

Written by

Ms Joyce Toh