While the nation has focused on opioid addiction, experts tell Healthline that benzodiazepines such as Ativan can also be addictive and dangerous.
We’ve heard plenty about the opioid epidemic.
But there’s another less recognized prescription drug problem: benzodiazepines like Ativan, Xanax, Valium, and Klonopin.
While doctors are prescribing fewer painkillers, prescriptions for these anti-anxiety drugs are still going up.
Like painkillers, “benzos” should be a temporary solution.
Many Americans don’t realize that their prescription is an addictive drug that, over time, is likely to aggravate their original problem.
People who use benzos regularly over months or years risk “dependence, addiction, cognitive damage, more falls, and death,” according to Stanford University psychiatrist Anna Lembke.
“Doctors also tend to overestimate the benefits. Long-term use can make insomnia, mood, and anxiety worse,” she told Healthline.
“They’re grossly overprescribed,” added Yale psychiatrist Swapnil Gupta. “Very often, I’ll see a patient who is managing their issues and they’ll say my family doctor gave me this to sleep and I’ll see 2 mg Xanax.”
Gupta told Heathline she often helps patients taper off from prescriptions from other doctors, a process that can take more than a year.
Meanwhile, teenagers are buying “Z-bars” — a 2-milligram (mg) dose of Xanax — on the street.
“Just as overprescribing opioids contributed to the use of heroin and illicit fentanyl and related deaths, overprescribing benzodiazepines may herald the dawn of a new era of illicit and deadly benzodiazepines,” Lembke warned.
The dangers of benzos
Besides anxiety, the Food and Drug Administration (FDA) has approved benzodiazepines for insomnia and other uses. They’re often prescribed alongside antidepressants.
The quantity Americans consume has more than tripled since the mid-1990s.
Benzos are involved in about a third of all deaths from prescription drug overdoses, typically combined with a painkiller.
Both drugs may have been prescribed, since 17 percent of Americans with an opioid prescription also used a benzodiazepine in 2013.
People also die when they take a benzo along with alcohol.
And even prescribed use can lead to a cycle of dependency.
Take a benzo nightly to sleep, for example, and you’ll typically get “rebound insomnia,” Lembke said.
Your “sleep effectively gets worse because of the benzodiazepine and the brain adapts to the benzodiazepine such that sleep becomes impossible without it,” she said.
When Gupta sees a patient experiencing panic attacks, she might prescribe Klonopin to use only during attacks. She’ll also limit the dose.
When patients show up with a prescription for insomnia, she can’t take them off it immediately because they’re addicted, she said.
“I tell them to try cutting the tablet in half,” she said. “It’s so hard to get off. You can get seizures, delirium, shakes. You can get suicidal. Sometimes the rebound anxiety can be much worse.”
“I’ve had people stop it completely over four to five months and have people who go back and forth over a year and a half,” she added. “At the same time, we’re working on other solutions: group therapy, acupuncture, and SSRIs. I make sure that every time they come in we spend 5 to 10 minutes on problems with benzos.”
Trying to withdraw
Janis gave up Ativan but later saw a new psychiatrist who put her on a cocktail of drugs that included 6 mg of Klonopin — 2 mg tablets that she was instructed to take three times a day.
“He never mentioned that it was addictive,” she told Heathline. “Every psychiatrist since then has said that’s a ridiculous amount [for a 130-pound woman].”
Over time, Janis lost her job, was sleeping 14 hours at a stretch, had bouts of slurred speech, and dropped down to a size 0 dress.
“People said I looked ‘drug addicted,’” she said, so she decided to quit Klonopin.
Working with a primary care doctor, she cut back her dose in steps over three years.
“Every time I reduced, I would be shaking, have headaches, my skin crawled, I’d be jittery and nauseated for days,” she said.
Janis was down to 1.5 mg when she decided to stop completely on her own. That was a mistake.
The shakes were “horrible,” and she was thinking about suicide, so she went to an emergency room and asked to be checked into a hospital.
Klonopin withdrawal can lead to seizures, so a psychiatrist at her hospital put her back on 3 mg, then cut back her dose over five days to zero. She spent those days on the floor, shaking and crying.
Benzos for a bad time
Antidepressants can take weeks to help and may increase insomnia and anxiety in the first month.
Psychiatrists sometimes prescribe a benzo just for that period, Gupta noted.
Nancy* took Ativan when she had reached a low. Her panic attacks had made her “unable to work or socialize or even leave my bed at times.” Her doctor prescribed Zoloft, and Ativan “as needed.”
“For me, it was a miracle drug, soaking up my anxiety like a sponge. It got me through that time,” Nancy told Healthline.
The Zoloft began working in a month, and after that, “just having Ativan in my pocket prevented countless anxiety attacks. I was able to give a talk and to date. Eventually, I did not need it at all,” she said.
But Nancy is now dependent on Ativan.
After the panic attacks subsided, she developed insomnia and resumed the Ativan at night.
“It helped me sleep, but I did need more and more to sleep as my body developed a tolerance and I discovered Ativan’s two bad side effects: amnesia and vomiting with alcohol. Now I take it with Ambien to sleep. Without them, I find I’m awake all night,” she said.
“For social and work purposes, I rarely need Ativan. I just keep it in my pocket and feel safe,” she added.
Weaning America from benzos
In 2015, the Veterans Administration kicked off a drive to cut back benzo use among veterans ages 75 and older, who often received a prescription years ago.
“It’s time for the medical community to take note that benzodiazepines prescribed long term are dangerous for patients,” Lembke said.
To manage insomnia, she told Healthline, skip the benzo and instead change your habits.
Rise early to enjoy morning sunlight, get daily exercise, limit caffeine after noon, stay on a regular schedule, and keep electronic screens away from the bed.
The standard antidepressants are the better medications for anxiety, she said.
Lembke analyzed the opioid problem in “Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop,” published in 2016.
In a recent New England Journal of Medicine opinion piece, she and two co-authors urged that the fight against opioids include benzos.