Today is World Benzodiazepine Awareness Day

Did you know about World Benzodiazepine Day? World Benzo Day is a day to reflect on issues of benzodiazepine side effects and withdrawal symptoms.

Benzodiazepine dependence is a major issue for people who have been prescribed benzodiazepine treatment for long term use. Prescribed benzodiazepines are a significant cause of iatrogenic injury, which, in this case, is injury to the central nervous system by a medically prescribed treatment.

While a benzodiazepine prescription should, in most cases, only be written for no more than a week or two, many patients are prescribed for much longer. Benzodiazepine use may continue for months, or even years, for conditions such as insomnia, anxiety or panic attacks.

Benzo dependence is not the same as benzo addiction. In fact, benzodiazepine addiction is rare. Most people who take benzos for an anxiety disorder or insomnia are physically dependent, not addicted.

What should I do on World Benzodiazepine Awareness Day?

Do you know someone who takes a benzodiazepine? Lorazepam, or Ativan, is a commonly prescribed benzo.

Maybe you know a family member who takes a small dose of lorazepam at bedtime to help them fall asleep. Are they aware that Ativan is a high potency benzo?

Ativan 0.5mg is the same strength as Valium 5mg. Additionally, taking a benzo for a long period can worsen physical dependence, benzodiazepine side effects, and the risk of benzodiazepine withdrawal.

Alprazolam, or Xanax, is another high potency benzo. Xanax 0.5mg is equal to Valium 10mg. Clonazepam, or Klonopin, is just as potent as Xanax.

It is important that benzo patients are aware of what they are getting into when they start taking one of the many FDA approved benzos. Part of World Benzodiazepine Awareness Day is educating doctors and patients on the importance of informed consent.

What is benzodiazepine informed consent?

When a doctor prescribes a medication, the doctor should review with the patient all possible consequences of taking that medication. For example, if a medication often causes physical dependence, and a difficult withdrawal syndrome, the doctor should discuss this clearly with the patient.

A benzo patient should be aware that taking a Xanax, Ativan, or Klonopin tablet at bedtime for many months, or years, is not harmless. Many people have great difficulty in tapering off of these medications after taking even a low daily dosage.

According to the Benzodiazepine Information Coalition, 40-80% of patients who are prescribed a benzodiazepine drug will have an issue with benzo withdrawal. Interestingly, they also state that only 0.2% of prescribed patients become addicted to benzos.

A small percentage of people who stop taking benzos will experience protracted withdrawal. Protracted withdrawal is a serious condition of side effects that can continue for months, or years, including benzo belly, akathisia, and ongoing insomnia and anxiety.

Benzodiazepine abuse, benzodiazepine misuse, or addiction is relatively rare. Drug addiction is very different from physical dependence.

Doctors should be clear with their patients of the risk of taking prescription medication for generalized anxiety disorder, panic disorder, or insomnia. A benzodiazepine prescription should be accompanied by an informed consent discussion.

When did benzodiazepines become so dangerous?

Many doctors and patients are under the impression that benzos are relatively harmless. When someone has a benzo overdose, and no other illicit or prescription drug is involved, they rarely die from respiratory depression.

The Drug Enforcement Administration has designated benzos as Schedule IV, which means benzos are considered to have a relatively low abuse potential.

Opioids are drugs that are well known for leading to substance abuse, addiction and overdose death. Benzodiazepines are far safer than opioids in these respects.

However, just because benzos are not highly addicting, and they do not kill users as easily as opioids, they are not safe drugs to take long-term for many people. In September 2020, the FDA acknowledged the dangers of benzodiazepines, requiring new documentation requirements.

What does it mean when a prescription drug has a black box warning?

A black box warning is literally a black box with a warning in it, placed in the approved product information literature that accompanies a prescription drug. Each bottle of benzos that arrives at the pharmacy has a folded piece of paper, filled with small print.

The paper documents side effects, adverse reactions, and various warnings. The black box warning is usually at the beginning of this document.

On September 23rd, 2020, the US Food and Drug Administration updated their black box requirement for all benzodiazepines. The new black box warning must warn patients about the serious risks and harms associated with taking benzos.

The FDA wanted to make it very clear that there are risks of overdose, withdrawal, and even life-threatening withdrawal reactions, including seizures. They felt that existing warnings in the literature were not adequate, which could explain doctors having a false sense of security in prescribing benzos.

Unfortunately, many health care professionals review drug literature at some point in their career, and they may not return to look at updates. The assumption they may make is that drugs are well studied before being released to the public, and the drugs themselves do not change, once they are on the market.

Prescription drugs are not as safe as we think they are.

Why do people think prescription medications are safe to take? When we go to the doctor, we expect a prescription. Doctors also have a similar perception and often try to solve all problems with just the right prescription medication.

Doctors believe that many prescription drugs are relatively safe, and the serious adverse reactions listed in the literature are very rare. Prescribing many medications seems like a safe bet, and they believe they are helping their patients.

Unfortunately, we do not always have a full understanding of the risk of taking prescription drugs, especially when the drugs are first released. Clinical studies performed to get FDA approval for a drug are limited.

When a drug is approved for public use, many more people will take the drug than were involved in the studies. When a drug has been on the market for years, we may discover that it is more dangerous than previously known.

In addition to benzodiazepines, we now know that many antidepressants are more dangerous than were initially believed. Drugs such as Prozac, Paxil, and Zoloft, which were thought of as safe for nearly anyone, are now known to cause physical dependence, withdrawal, and some serious adverse reactions.

It is important that doctors continue to review the literature to see what changes have been made to warnings associated with prescription drugs. Also, doctors should think twice before writing any prescription for any patient, first considering if it is absolutely necessary.

Is World Benzodiazepine Awareness Day on July 11th for me?

Do you take a benzodiazepine? Do you know which drugs are classified as benzos? Are you aware that some sleeping pills, such as Ambien, are very similar to benzos?

Does someone in your family take a benzo? Maybe a parent or sibling takes a benzodiazepine and thinks there is nothing wrong with it.

If you take a benzo regularly, you may want to reassess the situation and have a conversation with your doctor. Consider the possibility of tapering gradually and stopping treatment eventually.

On this day, we also celebrate the work of British doctor and scientist, Heather Ashton. Dr. Ashton created the Ashton Manual, which educates doctors and patients about benzodiazepines and how to gradually, safely taper off of them.

The benzodiazepine class of drugs are so widely prescribed that it is likely that someone close to you takes a benzo. If you are interested in learning more, you may want to visit the Benzodiazepine Information Coalition.