Why Benzo Withdrawal Syndrome is Deadly


Benzodiazepines, often abbreviated as benzos, are valuable, and sometimes lifesaving, drugs across a wide range of mental conditions. They were introduced as an alternative to barbiturates that were causing significant side effects in slight overdose cases, many of which even resulted coma or death.

benzodiazepine-withdrawal-symptoms

The major clinical advantages of benzos compared with other competitors are higher efficacy, better CNS specificity, faster onset of action, and lower toxicity. However, they're strongly recommended in short term use (2–4 weeks), not for months or years; withdrawal from extended use of them can be deadly (Ashton, 1994).

We will examine:

  • What are benzodiazepine withdrawal symptoms?
  • Why withdrawal symptoms are deadly?
  • How to cope with withdrawal symptoms?
  • Why should you avoid alcohol during withdrawals?
  • Why benzos are far more lethal when taken with opioid painkillers?

Popular Drugs in Benzodiazepine Group Include:

  • Xanax (alprazolam)
  • Klonopin (clonazepam)
  • Serax (Oxazepam)
  • Valium (diazepam)
  • Dormicum (Midazolam)
  • Ativan (lorazepam)

Benzodiazepine Withdrawal Symptoms


benzo-withdrawal-syndrome

Benzo withdrawal syndrome accompanies a physical dependence; the symptoms emerge when an individual, taking any medication of benzodiazepine group, undergoes dosage reduction or discontinuation. However, not everyone experience the complete list of possible symptoms, as the symptoms vary depending on mental and physical condition and from person to person (Onyett, 1989).

According to Petursson (1994), typical withdrawal syndrome can be characterized by:

  • Sleep disturbance
  • Increased tension and anxiety
  • Muscle aches, pains and spasms
  • Hand tremor
  • Headache
  • Sweating
  • Palpitations
  • Concentration problems
  • Confusion and cognitive difficulty 
  • Abnormal sensory perception
  • Panic attacks
  • Hallucinations
  • Seizures
  • Psychosis
  • Loss of memory
  • Irritability
  • Suicidal tendency

In high overdose cases, instances of more serious developments are also reported such as psychotic reactions, seizures, and suicide.

Why Withdrawal Symptoms are Deadly?

GABA-activity-brain-withdrawal-benzos

Benzodiazepines work by enhancing the activity of GABA, an inhibitory neurotransmitter responsible for brain's natural sedation. When GABA system is influenced by benzo, it slows or stops the functioning of other neurotransmitters and thereby reduces the brain's overall activity (Tallman and Gallager, 1985).

Within 6 to 8 weeks, benzo users may develop a tolerance. If the tolerance is developed, their brains then start needing progressively higher doses to get the GABA system firing at a 'normal' level (Onyett, 1989). However, the fear factor is that the larger the doses, the more pronounced adverse effects of benzos typically results.

Higher doses are thought to heighten the risk of both suicidal tendencies and depressive symptoms. Moreover, benzo side effects also include emotional blunting or numbness.

dopamine-molecule

Benzodiazepine withdrawal often comes with severe and life threatening symptoms. Sudden or over-rapid dose minimization from large doses can cause substantial damages to the user. Because if a user with a tolerance suddenly reduce the dose or stop taking the drug, decreased activity of GABA can abruptly increase the functioning of brain's excitatory systems (dopamine, noradrenalin, serotonin etc.).

This sudden enhanced activity of excitatory systems can cause increased tension and anxiety, suicidal thoughts and feelings, seizures, panic attacks, and even death (Allison and Pratt, 2003).

Management of Benzo Withdrawal Symptoms

A number of symptomatic patterns can result in a withdrawal from normal dosage benzodiazepine treatment. The first pattern is a short-term "rebound" anxiety and insomnia that comes within 1-4 days of cessation, though it depends on the particular benzo drug's half-life.

The second pattern usually lasts 10–14 days with the full-blown withdrawal syndrome. And, the third pattern may indicate the reappearance of anxiety and depressive symptoms that then last until some form of recovery treatment is introduced (Petursson, 1994).

depression-and-benzo-taper

Long-term benzo users require a comprehensive treatment strategy and a through medical supervision. An ideal treatment strategy should focus on completing a slow withdrawal protocol, coupled with reassurance, that provides outcome with marginal adverse reactions and risk to the patient.

Generally, the withdrawal process starts by slowly decreasing the dose and shifting the benzo user from a slower acting, to a longer acting, form of the drug. However, it can take up to 6 months for a complete recovery from benzo withdrawal syndrome (Ashton, 1991).

The success rate of benzo withdrawal depends on a number of steps, which include:

  • Individualized taper strategies based on withdrawal severity
  • Making users aware of the withdrawal reactions
  • Addition of alternative and supportive strategies such as cognitive-behavioral therapy, withdrawal support groups, reassurance, relaxation training etc.
  • Use of effective medications to ease withdrawal symptoms

Dosage Tapering

Anyone withdrawing from long-term benzo use must taper the dosage slowly but gradually. Slow withdrawal means reducing the dosage over a period of months, not weeks (Miller and Gold 1998).

For a benzo withdrawal syndrome, it doesn’t matter how long it takes to make you sober again. What's important is having stable progress towards your target while lessening your uneasiness along the way, because abrupt withdrawal, particularly from large dosage, can enhance severe symptoms.

The aim should be therefore to achieve a stable and slow decline of benzos in blood and tissue concentrations so that the brain can steadily go back to its normal state.


Short-acting Detoxification

7- to 10-day taper:​

Give 10 to 20 mg of diazepam (Valium), orally four times daily, on day 1 and then taper the dose until the dosage is between 5 and 10 mg orally on last day.

Don't give drug on an "as need" basis. If required, adjust the dosage but make sure it is in accordance with the patient's clinical state.

7- to 10-day taper:​

Give 50 percent of the actual dosage by calculating the benzo equivalence and then taper (if original dosage is identified before detoxification,). Don't give drug on an "as need" basis.

Long-acting Detoxification

10- to 14-day taper:

Give 10 to 20 mg of diazepam (Valium), orally four times daily, on day 1 and then taper the dose until the dosage is between 5 and 10 mg orally on last day.

Don't give drug on an "as need" basis. If required, adjust the dosage but make sure it is in accordance with the patient's clinical state.

10- to 14-day taper:​

Give 50 percent of the actual dosage by calculating the benzo equivalence and then taper (if original dosage is identified before detoxification,). Don't give drug on an "as need" basis.

In high overdose cases, instances of more serious developments are also reported such as psychotic reactions, seizures, and suicide.

Why Should You Avoid Alcohol During Withdrawals?

avoiding-alcohol-and-detox

If you're coping with withdrawal symptoms, you need to know that drinking alcohol can worsen your condition and may increase the risk of benzodiazepine dependence. Because, while you're on a detox, the activity of your GABA system is decreased and thus all messed up. To get it back to its 'normal' level, it needs to be normalized step-by-step. But, just like benzos, alcohol increases the activity of GABA neurotransmitters.

So if you drink alcohol during your detoxification, it'll certainly slow and hamper your brain's healing. And there is another reason to be concerned of. As your GABA system is messed up and desperate to enhance itself again, you may find drinking as a way to compensate and cope your withdrawal symptoms. Nevertheless, if you do this, there will be very low chances of your brain's healing. And, you may develop another new problem, that's alcohol addiction!

Warning: Never Use Benzos to 'Boost' Opioid painkillers

never-mix-opioids-and-benzos

In these days, drug abusers discovered a new way to abuse prescription drugs; it is abusing benzos with opioid analgesics. Many of these heard about it from somewhere and others have known about it on their own. However, using benzos to 'boost' the activity of prescription opioid painkillers is a far more lethal combination than you can imagine. It's a combination that can make you playing with living lightning.

Benzos and opioid painkillers can kill abusers on their own. Prescription opioids have been reported to cause about 12,000 deaths per year. But when the benzodiazepines were added to the painkillers, over 16,650 deaths were reported in 2010, that's another 30 percent (CDC, 2011)!

Medical References

About the Author:

Kara Crow is a substance abuse treatment consultant. She joined The Recovery Way last year and has been working to develop and implement new treatment strategies, and to analyze addiction treatment services. Learn more about her here and connect with her on Twitter, Facebook, Google+.

Kara Crow – who has written posts on The Recovery Way.


One response to “Why Benzo Withdrawal Syndrome is Deadly”

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