Commonly Prescribed Benzodiazepines
- alprazolam (Xanax, Xanax XR)
- clobazam (Onfi)
- clonazepam (Klonopin)
- clorazepate dipotassium (Tranxene)
- diazepam (Valium)
- chlordiazepoxide (Librium)
- lorazepam (Ativan)
- temazepam (Restoril)
- triazolam (Halicion)
Fast Facts About Benzodiazepines
A brief overview of the problems with prescribed benzodiazepines.
Scope of Prescribed Use
Alprazolam, clonazepam, and lorazepam are among the 10 most commonly prescribed psychotropic medications in the United States. Prescriptions are on the rise with at least 25.3 million (10.4%) adults in the United States reporting prescribed benzodiazepine use from 2015-2016, nearly doubling the 4-6% estimated in 2013-2014, with the highest consumers being those adults aged 50-64. From 2003 to 2015, the percentage of outpatient medical visits that led to a benzodiazepine prescription doubled, as well as the prescribing rate among primary care doctors. Additionally, the rate of co-prescribing benzodiazepines with opiates quadrupled from 0.5% in 2003 to 2% in 2015.
Indications and Safety
Long-term prescribed use (>2-4 weeks) can result in heightened anxiety, increased incidence of falls and accidents, persistent insomnia, impaired learning, higher rates of suicide, a greater risk of dementia, the development of new or worsening symptoms, and a reduction in efficacy of nonpharmacologic interventions for PTSD and Panic Disorder, impairing recovery from these conditions. Existing estimates are disparate indicating 20-80% of patients stopping a benzodiazepine will experience withdrawal effects, of which a percentage will be severe.
Current medical training does not provide adequate education about the risks of benzodiazepines or safe tapering practices. Therefore, many are prescribed to patients without full informed consent. An informal poll of patients prescribed benzodiazepines ≥4 weeks revealed that, of the 606 respondents, 570 (94%) reported receiving no warnings about physical dependence or withdrawal. Of those warned, many reported it insufficient in regards to the severity and/or difficulty of withdrawal.
Patients are often unable to obtain useful cessation advice from the prescribers, and frequently have their prescriptions abruptly stopped to their detriment. Inpatient “detox,” rapid taper, cold turkey and forced cessation are dangerous and inappropriate for prescribed patients. The result can be reinstatement, disabling protracted symptoms or death. Slow (≤5-10% every 2-4 weeks), patient-controlled tapers are the best way to discontinue use in patients agreeable to cessation.
Long Term Disability
Many patients while taking benzodiazepines, as well as during and after cessation, will experience long-term disability which may persist years. More research is needed to predict who will suffer detrimental effects from prescribed benzodiazepines and to determine how to help those already harmed.
For over 50 years, advocacy and support for harmed patients has been mostly handled by laypeople due to the lack of medical help for benzodiazepine-related injury. Although several patient-led movements and support groups have existed since the 1970s, there continues to be insufficient mainstream resources and medical recognition, resulting in sustained patient harm.