Benzo Dependence: Yes, It’s a Thing
Benzo dependence is a real condition. A very real condition. In fact, it’s so real that doctors have gotten together and given it a name. Complex Persistent Benzodiazepine Dependence, or CPBD. Throw opioids and/or meth into the mix and you’ve got the stuff of legend – dead legend.
Yet benzo prescriptions keep getting written by the boatload.
Benzos, or BZDs, are depressants. Just like alcohol. And like alcohol, they lower brain activity. Unlike alcohol however, they’re prescribed to treat a variety of conditions, including anxiety, insomnia, and seizures. Wiki says the first benzo, chlordiazepoxide (Librium), was discovered accidentally in 1955 and made available in 1960. The maker? Hoffmann–La Roche, who followed three years later with diazepam (Valium). By 1977, BZDs were the most prescribed medications in the entire world. Selective Serotonin Reuptake Inhibitors (SSRIs) put a dent in their use. So did more common sense prescribing. But they remain among the most-prescribed drug anywhere.
In addition to anxiety, insomnia and seizures, benzos are often prescribed to treat panic disorder, agitation, muscle spasms and alcohol withdrawal. They’re also widely used as a premedication for medical or dental procedures.
Short-term use (two-to-four weeks) is generally considered safe for most people. Long-term use not so much. In fact, Wiki also says long-term benzo use raises concerns about decreasing effectiveness, physical dependence, benzodiazepine withdrawal syndrome, and an increased risk of both dementia and cancer.
The elderly are at increased risk whether short- or long-term. So are the pregnant. And everyone risks mood swings, hallucinations, and depression.
A CDC National Health Statistics Report culling data from 2014–2016 National Ambulatory Medical Care Survey concerning benzo and opioid prescribing trends found some alarming numbers. In the first place, benzodiazepines were prescribed in 27 of every 100 annual visits. Among those visits, approximately one-third involved an overlapping opioid prescription. In other words, a full 10% of people walked away with prescriptions to both benzos and opioids. 10% of annual visit for a rate of 10 annual visits per 100 adults.
The report goes on to say that despite concerns related to the long-term use of benzodiazepines,
benzo prescription rates increased from 4.1% in 1996 to 5.6% in 2013. The number of ambulatory visits with one or more prescriptions for a benzodiazepine went from 27.6 million in 2003 to
62.6 million in 2015. And overdose deaths involving benzos increased
from 0.58 per 100,000 adults in 1996 to 3.07 in 2010. That’s nearly four times the amount in just over a decade.
It gets worse. Much worse. National Institute on Drug Abuse (NIDA) found there were 11,537 benzo-related overdose deaths in 2017. Approximately 85% of those deaths also involved an opioid. We couldn’t find more recent numbers, but COVID alone is likely to have cause a significant spike in benzo prescriptions. Considering the opioid overdose rate has done nothing but increase, well, there’s almost no need to even do the math.
There is however a need to do something, beginning with more sensible benzo prescription practices. Fortunately, an Oregon-based non-profit aims to do just that. The outfit is called Benzo Reform. And it seems to be just what any sane doctor would order.
Make that any sane doctor, pharmacist, professor, policy maker and scientist, as well as anyone else who cares about the health of our world. See Benzo Reform is actually the name of the goal (and the website) rather than the outfit itself. The outfit is actually called The Alliance for Benzodiazepine Best Practices. Yes, it’s a bit of a mouthful. Then again, the name benzodiazepine is a mouthful. Come to think of it, the unwieldy name may be one reason why comparatively little alarm has been raised over the issue.
Whatever may or may not be, yesterday is over. And if the Alliance has its way, it’ll stay over too. Because it’s assembled a team that is as experienced as they are dedicated. It’s also on a mission that’s as sensible as it is necessary. Marry the twain and you’ve got the makings of a much brighter tomorrow.
And some very serious reform. The Alliance mission, in brief, is “to make evidence-based improvements to the prescribing of benzodiazepines and Z-drugs.” Z-drugs are Zopiclone, eszopiclone, zaleplon and zolpidem. They first came to market in the 1990s. And while Z-drugs have thus far only been approved for insomnia, they’re more and more popular among the pill-popping set.
Anyway, the Alliance calls for a complete reassessment of Benzo prescription practices. In fact, they also call for Benzo de-prescribing. That’s right. For this group, Benzo harm generally outweighs the good, and the less those drugs are circulated the better off we’ll be.
And we quote:
The Alliance’s “primary objective is to significantly reduce the number of benzodiazepine withdrawal sufferers by reducing the number of new prescriptions for benzodiazepines and Z-drugs, limit the duration of use, and provide an evidence-based pathway for deprescribing. Our focus is to illustrate the problems associated with benzodiazepines, illuminate alternatives to their use, and provide tools for clinicians to assist benzodiazepine withdrawal syndrome sufferers. A complementary objective is to develop and promote best practices in benzodiazepine prescribing and problem management.”
It doesn’t get any simpler or more matter of fact than that.
Complex Persistent Benzodiazepine Dependence
Decades of benzo over-prescribing of course created a rather significant number of benzo addicts, especially in America. Well, the BZD addiction has persisted for so long, and to such a deleterious degree, that, as mentioned, a group of physician-scientists have finally named the condition. That brings us back to Complex Persistent Benzodiazepine Dependence, or CPBD.
Are you dizzy yet?
Well, we are. And if the numbers are any indication, a lot of other stakeholders are dizzy too. Dizzy and fed-up. Witness the above-cited Alliance. And witness the physician-scientists behind this christening. These folks don’t simply name things for fun. No, they name things because the things need to be addressed. And there’s no addressing something that’s nameless.
This particular group of physician-scientists hails from the Oregon Health & Science University School of Medicine, as well as the VA Portland Health Care System. And like the above-cited Alliance, they want to see real reform.
Christopher K. Blazes, M.D. is among the CPBD fighters looking the make a name mean something. Dr. Blazes is an assistant professor of psychiatry in the OHSU School of Medicine, as well as the director of OHSU’s addiction psychiatry fellowship. So he knows a thing or three about behavior – and about BZDs.
“This is really a dangerous situation,” the good doctor told Science Daily. “We now know that long-term benzodiazepine prescribing is rarely indicated, but we are still left with the problem of helping those who have been on these medications for years. The process of discontinuation can be very challenging and even dangerous. There may even be some circumstances, when attempts to discontinue fail, that restarting safe doses may be indicated.”
Blazes was joined in the coining by OHSU School of Medicine colleagues and study co-authors Linda Peng, M.D. and Thomas W. Meeks, M.D., who allied with the Portland VA before publishing a viewpoint in the journal JAMA Psychiatry.
Dr. Peng is an assistant professor of medicine (general internal medicine and geriatrics) and Dr. Meeks is an assistant professor of psychiatry, as well as the Medical Director pf the Substance Abuse Treatment Program & Opioid Treatment Program for the Portland VA Health Care System.
“The opioid crisis has dominated headlines, yet benzodiazepines are an underrecognized and important contributor to the public health crisis of drug overdose deaths,” wrote the authors.
Furthermore, all long-term benzo patients will develop physiologic dependence. That means they’ll require escalating doses, and will experience withdrawal symptoms when they stop taking the drugs.
Dependence vs Addiction
But dependence is different than addiction, insist the authors. And that distinction is another reason for the new term. Most CPBD patients don’t have addictions that result in sacrificing jobs, relationships or personal stability. It is only during the discontinuation process that anything like addiction occurs.
Blazes says the distinction is important because treatment for addiction differs from treatment of dependence.
“You don’t want to diagnose addiction if people don’t have addiction,” he said. “People who don’t have addictions aren’t going to respond as well to psychological-social and behavioral interventions that work for addiction.”
Apples to oranges? That’s for you to decide.
Healing Properties recognizes the hazards and harms caused by benzo over-prescribing. We also recognize the hazards of mixing benzos with opioids. In fact, we’ve seen the results of ignoring such hazards. And they’re not pretty.
We are however encouraged to see physicians, scientists (and physician-scientists) and other health-conscious stakeholders stepping up to the plate and addressing the issue. Whether these stakeholders are coming up with mitigating names or designing full blown missions, their efforts are essential. And we applaud each and every one of them.
How about you? Have you a benzo issue? Are you ready to step away? Could you use some help? Then give us a call. We’ve been helping men get clean for 20 solid years. We’d be honored to help you too. All you’ve gotta do is call.
(Image courtesy Wikimedia Commons)