bENZODIAZEPHINE MEDICATION

Overview & Background

  • Benzodiazepines are frequently prescribed psychotropics in the U.S., particularly among adults aged 50–64. Millions of prescriptions are dispensed yearly, and the practice of co-prescribing with opioids has significantly increased.

  • Prescribing information often downplays key risks such as physical dependence, withdrawal, and long-term harm

Commonly Prescribed Benzodiazepines

The site lists the following widely used benzodiazepines:

  • alprazolam (Xanax, Xanax XR)

  • clobazam (Onfi)

  • clonazepam (Klonopin)

  • clorazepate dipotassium (Tranxene)

  • diazepam (Valium)

  • chlordiazepoxide (Librium)

  • lorazepam (Ativan)

  • temazepam (Restoril)

  • triazolam (Halcion)

Indications & Short-Term Risks

  • These medications are typically used for anxiety, panic, insomnia, seizure control, and muscle relaxation.

  • Use beyond 2–4 weeks significantly raises risks:

    • Heightened anxiety, falls, persistent insomnia

    • Cognitive impairment and diminished response to PTSD or panic therapies

    • Increased suicidal thoughts and dementia risk ﹘ though dementia findings remain debated.

Dependence, Tolerance & Withdrawal

  • Tolerance: Over time, users require higher doses to achieve the same effect.

  • Interdose withdrawal: Symptoms can arise between doses as the drug wears off early.

  • Physical dependence can develop even at low doses after 2 or more weeks.

Withdrawal & Deprescribing

  • Around 20–80% of people stopping benzodiazepines experience withdrawal symptoms, which vary in severity. Some face protracted symptoms lasting months or years.

  • Safe tapering typically involves dose reductions of 5–10% every 2–4 weeks. Abrupt or rapid cessation can cause seizures or even death.

  • No medications are officially approved for benzodiazepine withdrawal relief. Off‑label options such as carbamazepine, propranolol, trazodone, and quetiapine are sometimes used but carry their own risks. Some users report relief from CBD or medical marijuana.

Risks with Cessation (Deprescribing Risks)

  • Harms can stem not just from prolonged use but from poorly managed quitting:

    • Kindling: repetitive withdrawal episodes leading to progressively worse symptoms

    • Psychological trauma, akathisia, functional brain changes

    • Risk of suicide, especially in forced or abrupt cessation scenarios

Special Populations & Considerations

  • Elderly: Benzodiazepines are on the Beers List for older adults due to elevated risks of falls, confusion, and prolonged sedation.

  • PTSD/Veterans: Often contraindicated and can worsen PTSD symptoms or depression.

  • Women, children, incarcerated populations: These groups may be especially vulnerable to severe withdrawal or misdiagnosis when injured.

Informed Consent & Prescribing Practice

  • A vast majority of patients (≈94%) report receiving minimal or no warnings about dependence or withdrawal when first prescribed benzodiazepines.

  • The site strongly critiques current medical training and prescribing norms for underestimating risks and not properly educating prescribers and patients.

Benzodiazepines are medically useful for short-term treatment of anxiety, panic, insomnia, and seizures but they carry serious risks when used beyond 2–4 weeks. Physical dependence and withdrawal are common even at low doses. Safe deprescribing demands a slow, individualized taper. Lack of prescriber education and patient warning further exacerbates harm, especially in vulnerable groups.