Two new benzodiazepine studies have been published recently and both reveal concerning (albeit unsurprising to benzodiazepine safety advocates) results:
Benzodiazepine Use and Misuse Among Adults in the United States
The first, a study entitled “Benzodiazepine Use and Misuse Among Adults in the United States,” was published in the journal Psychiatric Services. The study’s lead researcher, Dr. Donovan Maust of the University of Michigan’s Department of Psychiatry, and his colleagues analyzed data from the 2015 and 2016 National Survey on Drug Use and Health (NSDUH), an annual nationwide survey funded by the U.S. Substance Abuse and Mental Health Services Administration. The goals of the study were to determine prevalence of benzodiazepine use (both as prescribed and misuse), characterize misuse, and examine variation by age.
In light of long-established benzodiazepine risks and harms, the data revealed by this study is alarming:
1. A total of 30.6 million adults (12.6%) reported benzodiazepine use in the past year—25.3 million (10.4%) as prescribed and 5.3 million (2.2%) misuse. That figure is almost double the between 4-6 percent estimated by studies in 2013 and 2014, although the authors of this study point out that the differences may be due, at least in part, to differing survey methodologies.
2. Misuse—described as “any way a doctor did not direct,” including using the drugs without a prescription, taking higher doses than prescribed, or taking them more often or longer than prescribed—accounted for 17.2% of overall use. Young adults, aged 18-25, were revealed to be most likely to misuse. In response to that figure, Dr. Donovan Maust is quoted as saying, “If you look at younger adults, basically misuse was as common as prescribed use, which obviously is kind of disturbing.” Misuse of benzodiazepines declined with age, Maust and colleagues discovered: 3.3 percent among those aged 26 to 34; 1.7 percent among those aged 35 to 49; 1.4 percent among people aged 50 to 64; and just 0.6 percent among people 65 and older. Misuse and abuse of or dependence on prescription opioids or stimulants were strongly associated with benzodiazepine misuse. Benzodiazepine misuse without a prescription was the most common type of misuse, and a friend or relative was the most common source. Adults ages ≥50 were more likely than younger adults to use a benzodiazepine more often than prescribed and to use a benzodiazepine to help with sleep.
3. While some previous studies have pointed to seniors age 65 and older as the most prevalent users of benzodiazepines, results of this study revealed that adults ages 50-64 had the highest prescribed use (12.9%).
According to several news outlets, including the Chicago Tribune, Dr. Maust offered the following commentary in reference to his study’s findings: “Benzodiazepines are being prescribed far too frequently, given that evidence reviews have shown that benzos are of little to no value in treating anxiety, panic disorders or insomnia. Cognitive behavioral therapy and psychotherapy often outperform benzodiazepines, and the drugs have been shown to actually interfere with the effects of such proven treatments. Benzos for anxiety is like opioids for chronic pain. There’s a small subset of patients with treatment-resistant conditions where use may be appropriate. The current amount of use way, way exceeds what the evidence would support.”
Patterns in Outpatient Benzodiazepine Prescribing in the United States
The second, a study entitled “Patterns in Outpatient Benzodiazepine Prescribing in the United States,” was published in the journal JAMA Network Open. Using nationally representative National Ambulatory Medical Care Survey data, Sumit D. Agarwal, M.D., and Bruce E. Landon, M.D., from Harvard Medical School in Boston, quantified patterns in outpatient benzodiazepine prescribing and compared them across specialties and indications. Data on more than 386,000 doctor visits from 2003 through 2015 was analyzed.
The results of this study were also concerning:
1. The percentage of outpatient medical visits that led to a benzodiazepine prescription doubled—increasing from 3.8% to 7.4%—from 2003 to 2015.
2. The prescribing rate amongst psychiatrists remained unchanged at about 30% of visits. Otherwise, the prescribing rate increased among all other physicians—the rate among primary care doctors more than doubling, increasing from 3.6% to 7.5% of visits. In other words, visits to primary care physicians accounted for approximately half of all benzodiazepine visits.
3. The benzodiazepine visit rate increased by 6.9% for anxiety and depression; by 1.9% for neurologic conditions; by 4.9% for back and/or chronic pain (both non-FDA-approved indications); and by 2.6% for other conditions. Use did not change for the indication of insomnia.
4. The rate of co-prescribing benzodiazepines with opiates quadrupled from 0.5% in 2003 to 2% in 2015. (Note: In 2016, the FDA issued its strongest warning about serious risks and death when combining opioid pain or cough medicines with benzodiazepines. Only time, in addition to further analyzation of data beyond 2015, will tell if warnings have been heeded).
5. The co-prescribing rate of benzodiazepines with other sedating medications increased from 0.7 to 1.5%.
Source: Sumit Agarwal, Brigham and Women’s Hospital
Credit: Koko Nakajima/NPR
“Surprisingly few guidelines exist for a medication that is prescribed by so many different types of physicians and for so many different indications,” the study authors conclude. The researchers also say that benzodiazepine-related overdose deaths have significantly increased from 0.6 per 100,000 adults in 1999 to 4.4 in 2016. “In light of increasing death rates related to benzodiazepine overdose, addressing prescribing patterns may help curb the growing use of benzodiazepines,” they state.
According to Medscape Medical News, Dr. Agarwal offered the following commentary in reference to the study’s results: “The pendulum has begun to swing in how we prescribe opioids, but we really need to be cautious in how we prescribe benzodiazepines too. Benzodiazepines are easy to start but hard to stop. I’m surprised that we’re not talking about this more. This has been called our ‘other’ prescription drug problem.”
To learn more: This study was covered by various outlets including Medscape, The Hill, MPR, NPR, and MedShadow. It’s important to note, however, that the language in some of these articles fails to make the very critical distinction between addiction (or the term “addictive”) and prescribed physical dependence.
Its horrible that persons been depended for many years dont get a proper taper clinic!!! Here in Sweden the so called clinic often dont even know dr Ashton!!!!!! the most famous in the field. Shame on them!!! i Think that is economic, it costs to much to taper for long time!! so its cynic and people suffer very much and even commit suicide cause of that. and its even a shame attiute to the patiens!!!! VERY BAD I I RECOMEND U TO LOOK AT THIS!!! ITS A NIGHT MARE.!!!!!
Nice post! This really gave me more knowledge about benzodiazepines. Thanks a lot for posting!
Hi. I just found this. I was on high dose clonazepam every day for 15 years. I was relatively ok during that time compared to the last 12 months.
I went to a hospital some time ago after I tried to taper from 8mg clonazepam to 6mg then 4mg then 2mg and zero, but unfortuantly I had no script. I *think* my psychiatrist refused to fill it.
I went to a local ER. There, I was hallucinating and in INTESNE fear. I could see ghosts and spirits crawling in and out of vents as if I were in the TV show Supernatural. It was terrfiying. But little did I know it was actually the beginning of a terrible nightmare.
I have been on very high dose methadone for 20 years as well, plus Mirtazapine and Quetiapine and Atenalol. I had no meds and the psychiatrist at the hospital saw me and even though it was at least 24 hours after my last dose, refused to give me ANY meds aside from 100mg Quetiapine.
I told him that this was a terrible mistake, and that I would likely have seizures, delerium and panic attacks (amongst others). He said “well your in a hospital, we can keep an eye on you”. I then did a very suicidal act in my despereate state and was literally hauled to a psych ward and given an order to stay there in a locked ward with people very very mentally unwell. There were meals, but no food and I have horrible panic attacks from what I suspect is hypoglycemia. With a lack of sugar, and being cut off from a beta blocker, Mirtazapine, Clonazpam and Methadone, I soon became EXTREMELY “agitated” and freaked out in horrible, serious ways and was hauled repeatedly to a “seclusion” room. These rooms are always freezing cold, there is a terrible foam mattress and no toilet plus a mirror on the wall. In there I freaked out more, thinking it was a jail cell. I then got more agited and fearful, wondering WHY I was suddenly abandoned by my origonal psychiatrist and doctor in the community. I was going through high dose methadone withdrawals (from 120mg to 5mg) and also high dose clonazpam withdrawals and lack of beta blocker. My heart felt like it was going to explode and I was hallucinating badly; and was absoultely unable to even complain at this point. Soon I had MANY seizures along with intense vomiting, body pains, everything looked COMPETLY different and I was unable to know what I was realy smelling (everything smelled disgusting; even the antipsychotic pill coating would make me vomit up my meds). I was hearing all kinds of things; and my awareness was GONE.
I complained further asking for meds and a doctor. I was told “I can’t do anything for you, but a doctor will be here (a GP) in 5 days”. I was so hopeless I would have killed myself a thousand times if needed be. I ended up self harming, and becoming even more insane. I vomited SO MUCH that I was eventually put on a drip in intensive care for 4 days (maybe more). I had more seizures. I was shaking uncontrollably and even a cup of tea was impossible to hold without spilling. Being around others I had prolonged panic attacks – what agoraphobia “looks like” in depictions in movies (where the person walks, the hallway becomes huge, and bends) and I was vomiting even when I was returned to the psych ward. I didn’t sleep for weeks – only 20 mintues here and there…I became very anxious and depressed plus very very insane. I was told that I needed ECT. I didn’t like this idea at all and asked for meds. My family said “I don’t need pills” and the doctor refused to listen. He put me on a DIFFERENT antidepressant even though Mirtazapine was better (I can’t sleep nearly as well on SSRI’s on Tricyclics) and I refused to take the prescribed Venlafaxine because I had read accounts of others on it who severe “discontinuation syndromes”. So I did take a SSRI and was given tryptophan to “help with sleep”. It did nothing.
I was so despeate and frustrated I smashed my head in to a wall several times. I told my family I did NOT want ECT but they thought that the psychiatrist I saw was “a great doctor” (because “he seemed nice” and mainly because he thought “I didn’t need pills” as well).
I told them the reasons for tapering slowly – but instead had to be cut off cold turkey after daily use for at least 15 years. I was not a drug addict but I was placed with a LOT of them. I experiernced assaults (“all kinds”) and was terrified. Things got stolen daily. Thankfully nurses were kind, as were most other patients who were coming off their meds or drugs and/or recovering from suicide attempts (or both). I ended up staying for over 4 months! It was so insane. Sadly, by the time I was in the ward for 48 hours, my family thought that because the psychiatrist and doctors “seemed great” and becasue they NEVER went though any CNS depressant withdrawals – they thought that cold turkey “isn’t that bad, after all your in a hospital”. I tried to explain and to get a second opinion but was told that I couldn’t have one.
After vomiting, having intense stomach, back, urinary, and head-aches, plus at least 5 seizures, I was so insane I was unable to communiate clearly and was treated as if it was “all a part of being unwell”.
I got out but still have intense panic and severe sleeping issues. Any long dormant cravings for opioids and CNS depressants have returned with a vengence. I haven’t slept properly for 5 months. I had so much confusion I was barely able to keep clothes on! I was walking around in a state of extreme fatigue from so much vomiting, seizures, and I had what I call “jackhammer in my body” and had to do EVEYRTHING I could to sit still and not let my entire body and limbs twitch and jerk like…a jackhammer was controlling my bones. Even 3 to 3.5 months later I was unable to make a cup of tea without shaking so bad that I would spill it everywhere and have to start over (often trying 5 or 8 times). I’m getting better s l o w l y but its still very hard.
I had many ECT sessions and because I coudln’t have a say (to refuse them) I would shake in fear of the doctor. My memory got so bad I coudn’t even identify nurses and I was acting like a very old person with severe alzhimers. When I think about being forced to stop long term mirtazapine, beta blocker, clonazpam, and a DRASTIC cut in methadone plus a big drop in antipsyhotic, I get such intesne fear that if I’m in that situation again, I will most likely kill msyelf instead of going through that again.
Its terrible cos most of the people there are there because they overdosed, tried to kill themselves, and/or were addicted to meth or coke or heroin, but NONE were stopping benzos!
I can’t belive that in this day and age, a person can tell a doctor that they will go through immense suffering and have seizures (amongst the rest – I had tinnitus, plus virtually ALL the withdrawal symptoms) and still be denied meds! It’s torture and literally HELL. I asked for a taper repeately. I asked for my oringonal antidepressant. I asked for higher doses of an antipsychotic at least but was denied becasue “they have side effects” and because “but a benzo might make you feel good”. I had NO histroy of misuse of meds! I DO now because I told them anything and evertyhign in an attempt to get meds after being ignored for months! I only recently (within the last couple of weeks) got out of intense psychosis and am still struggling to keep my sanity and to sleep at night. I can’t imagine what it would be like if i had no home to go to after 4+ months in a psych ward. I know i’m far luckier than others. But I am terrified of this happening again, even with my current meds (an SSRI and antipsychotic and tryptophan). I had acute agitation several times and was diagnosed with austism spectrum and depression and psychosis. But I can’t find ANY info about ECT being used to treat autism specturm and I feel that this diagnosis is an easy way to ignore my actual feelings as is saying “your unwell (mentally)”. Just saying that doesn’t somehow EXCLUDE the effects from MULTIPLE CNS depressant, antidepressant, etc. withdrawals or “discontinuation syndrome”. I can’t bear to think about this because it fills me with panic and dread. I am convinced that a taper would be the better solution – I COULD have tapered over FOUR MONTHS (or more!) but was CUT OFF in just 24 HOURS. I try and try to explain this to my family but they tell me “your better now” and that “they were great” (the doctors). But I know different. I had NO IDEA in the past about how patients, inc. those with autism spectrum – felt slighted or treated less than “other (mentally well) patients”. But I understand now. Don’t get me wrong – the nurses were great. They just follow “what the doctor orders” and probably don’t agree with cold turkey from benzos plus a virtual cold turkey from high dose methadone (120mg to 5mg) plus being denied the beta blocker I was on for over a decade! I knew beta blockers were helpful in opioid and benzo withdrawals but was denied one “because I didn’t need it”. This is INSANE! It ruined my life. But had the psych at the hosptal done a slow, outpatient taper (perhaps admitting to hospital when I hit 2mg or 0mg) it would have been much better. How one does it – a taper or cold turkey – both equal benzo free – but one is far more preferable to the other. I sometimes think they did this to ensure they had a good chunk of work during this time. It was horrible. I was there the longest and only one person had even been there 3.5 months. I don’t know what to do if I relapse (having had meds cut off, this would be illicit drugs) and am scared of becoming an alcholic. I don’t like alchol but this state is horrible. Too much anxieity and not enough sleep. Its just horrible. Thanks for writing this and other aritcles – because a LOT of doctors dont understand the suffering that a person can go through and can be wrongly thought of as “just being mentally unwell”. Words can’t describe the fear! Thanks.
I completely understand, my wife is slowly weaning off. We are under 1mg and its still hell. Its affecting her vagus nerve which i’ve been reading stories that it can happen. I cant believe this pill is even allowed to be used it should be banned. I have the most emapthy for you. Thank you for post and it helps me understand my wife’s ordeal.
SCOTT JEFFREY PEARSON klonopin. 34years ?
I’ve been t on monolith at age 32 now I’m 65 3 mil. a day. Physicist who prescribed it , here in Florida.
Cold turkey in 2015 and almost died. Now the doctor want to take me off.? Just one of many stories including oxycodone. Please pray for me?
Thank you so much for all your work trying to help others. I am also post benzo and have found some relief by stimulating the vagus nerve system. That is the calming side of the nervous system. There are certain points on the body that you can used to stimulate it yourself. I don’t know how many people have tried this, or who really works for, but hopefully this helps someone.
Hello, I am writing from Ecuador, I was born in NY but I came to live here.
For 7 years I have been taking Clonazepam and when I wanted to take it off, the doctor told me to cut in half for 3 weeks and the abstinence was horrible, to the point that I urinated every hour and my bladder was very painful, among other symptoms, I though was going to die. I saw several specialists among those an Urologist and what the diagnosis was that I needed a widening of the urethra and he did it, leaving me with a strong pain and according to the other doctors indicating that this was not necessary. Now I am doing a slower reduction but sometimes I would like to return to the initial state, I take betablockers because I had tachycardias as a result of this but my heart thank God and the Virgin has no harm but I wish to leave the betablocker I would like to know what you think about this . On the other hand I would like to know if although I do not live there In USAcan send my complaint to the FDA and if as an organization you have tried to approach the government to force the pharmaceutical companies to investigate the tolerance of benzodiazepines and create a medical solution to avoid all the suffering from the hook. Thank you in advance for your information
So sorry to hear of your suffering, Veronica. Re: reporting your adverse drug reaction to the FDA, most likely they will only accept your report if the medication you took was prescribed in the USA. If you were prescribed in Ecuador, it appears you should be able to report here: https://www.controlsanitario.gob.ec
You can also complete an RxISK Report: https://rxisk.org/report-a-drug-side-effect-2/
Hope this helps. Take care and good luck as you progress in your taper.
A doctor ( psychiatrist ) did NOT, NOT ween me off of 4 months of being on Xanax.
I had seizures and he put me in the hospital, lying, saying i was psychotic. He put me on
deadly, Thorazine. He lied. The Thorazine made me a Zombie. It is like a “chemical
lobotomy”, as Dr. Peter Breggin points out in his book “TOXIC PSYCHIATRY.” A must
read for anyone or any family that has been harmed by psychiatric drugs.
Eventually another smart psychiatrist told me to throw the Thorazine in the toilet.
Everyday has been torture since first starting on Xanax. Xanax created a chain of
physical problems, and unrelenting, profound insomnia. All these drugs are dangerous !
Thank you Nicole Lamberson! The off label and prolonged prescribing of benzodiazepines have resulted in disability of thousands of unsuspecting patients. Like you, I was a medical insider that believed the hype of those that promoted the wonders of benzos. My particular interest is DID (Drug Induced Dementia). The public needs to be warned. You are helping.
Understand. My thoughts and prayers are with you!