Benzodiazepines: A new epidemic

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In recent years, the opioid epidemic has garnered attention in the media and from policymakers due to the increasing number of fatalities at the hands of overdose and drug abuse. However, lurking in the shadow of the opioid crisis’ spotlight, a different but also lethal class of drugs threatens to claim an ever-growing number of lives if left unchecked. 

Benzodiazepines, a type of medication commonly known as tranquilizers, are often prescribed to treat anxiety, insomnia, alcohol withdrawal and seizures . They are also increasingly used to alleviate chronic pain such as back pain. Common benzodiazepines include Valium, Ativan and Xanax . 

A study released in JAMA Network Open on Jan. 18 revealed that outpatient benzodiazepine prescriptions have increased dramatically in recent years. The percentage of outpatient appointments leading to such prescriptions doubled from 2003 to 2015, with about half of this value coming from primary care physicians. The study also revealed that the number of continuing prescriptions, indicating long-term usage of such drugs, increased by 50 percent. 

Benzodiazepines calm and sedate patients by raising the levels of GABA, an inhibitory neurotransmitter, in the brain. This may relieve anxiety, but it also poses serious threats to the patient when abused in large doses, leading to respiratory depression, altered mental status and, in extreme cases, death . According to Dr. Sumit Agarwal, an internist, primary care physician and researcher at Brigham and Women’s Hospital in Boston, people do not “realize that benzodiazepines share many of the same characteristics of opioids .” Benzodiazepines, when used chronically, can cause physical dependence and addiction, leaving a victim unable to survive without the very substance that may kill them. 

Past studies have indicated a large rise in overdose mortality rates at the hands of benzodiazepines, from 0.6 in 100,000 people in 1999 to 4.4 in 2016. In addition, the mortality rate for women due to these medications has increased by 830 percent between 1996 and 2017. As women are more likely to be treated for mental disorders such as anxiety and depression, they are disproportionately prescribed these drugs and thus more susceptible to developing dependency. 

In addition, since 2003, co-prescriptions of benzodiazepines with opioids have quadrupled. Since both kinds of drugs suppress the central nervous system, they exert a complimentary effect on each other that increases the chance of overdose and death. 

While these medications can be effective to treat conditions such as anxiety, their effectiveness in other scenarios has been highly questioned. According to Dr. Joanna Starrels, an associate professor at the department of medicine at the Albert Einstein College of Medicine, benzodiazepines do not appear to be effective treatments for chronic pain, and other therapies have been found to be more successful for treating insomnia, such as better sleep hygiene and talk therapy.  

The vast increase in benzodiazepine prescriptions can be traced back to primary care doctors rather than psychiatrists. According to Anna Lembke, an associate professor of psychiatry at Stanford University School of Medicine, this is a result of  “the incredible burden of care on primary care physicians” who often treat a large volume of patients and may work in more rural areas where specialists who are more trained to handle specific psychiatric and pain disorders are not available . Dr. Starrels believes that in general, primary care doctors “have not received the training that they need to prescribe medications that have such high risk for addiction or overdose.”

It is vital that physicians, patients, and policymakers alike address the growing benzodiazepine crisis before it claims more lives and reaches epidemic levels similar to those of opioids. Physicians must receive the appropriate training to avoid prescribing these drugs unless completely necessary, and governmental/societal efforts must be made to ease the burden on these doctors and provide resources such as psychiatric specialists to underserved areas. In addition, lawmakers must recognize the serious threat posed by these medications and pass more laws limiting their use. Finally, and most importantly, the general population must become fully aware of the dangers of benzodiazepines, limiting their exposure to such drugs before use turns into abuse.


Kate Lee is a contributor to The Daily Campus opinion section. She can be reached via email at Katherine.h.lee@uconn.edu.

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