I got the call every addiction doctor dreads: A patient of mine nearly overdosed. He had a long history of addiction, starting with opioid pain pills in his teens after a sports injury and progressing to heroin by his early 20s. He had been in recovery for six months.

“Was it heroin?” I asked the doctor, who was calling from the emergency department.

“Not opioids,” said the doctor. “Benzos.”

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“Benzos” is shorthand for benzodiazepines, a class of drugs often used to treat anxiety and insomnia. The dozen or so different types include Ativan, Klonopin, Valium, and Xanax. Most people have heard of them. More people than you might think are taking them (three benzodiazepines are in the top 10 most commonly prescribed psychotropic medications in the United States). Yet few people realize how many people get addicted to and die from them.

As my colleagues, Jennifer Papac and Keith Humphreys, and I write in this week’s New England Journal of Medicine, we need to pay more attention to America’s other prescription drug problem — the hidden epidemic of benzodiazepine use and abuse.

Between 1996 and 2013, the number of adults who filled a benzodiazepine prescription increased by 67 percent, from 8.1 million to 13.5 million. Unlike opioid prescribing, which peaked in 2012 and has decreased nearly 20 percent since then, benzodiazepine prescribing continues to rise. The risk of overdose death goes up nearly fourfold when benzodiazepines are combined with opioids, yet rates of co-prescribing benzodiazepines and opioids nearly doubled between 2001 and 2013. Overdose deaths involving benzodiazepines increased more than sevenfold between 1999 and 2015.

I spoke with my patient by phone a few days later. He was doing better — happy to be alive. I specifically asked him what he had taken and how he had gotten it. I knew he wasn’t getting benzodiazepines from a doctor’s prescription. I check the prescription drug monitoring database regularly, and he didn’t have a benzodiazepine prescription on record. Did he purchase Z-bars — a 2-milligram bar of prescription Xanax popular among teens and young adults — on the street?

His response was surprising, and scary.

He obtained clonazolam, the benzodiazepine that nearly killed him, from a website. The name is a mashup of clonazepam and alprazolam, the generic names for Klonopin and Xanax. Clonazolam is a highly potent benzodiazepine manufactured in laboratories in the United States and elsewhere. Sold as a “research chemical,” it can be shipped virtually anywhere. It is so potent that it needs to be dosed at the microgram level — millionths of a gram — using a high-precision scale.

My patient knew that clonazolam is potent, but didn’t realize just how powerful it is. He lacked a precision scale, and instead figured he was safe by measuring out just the smallest amount.

“The amount I took,” he told me, “wasn’t enough to cover a fourth of my pinkie fingernail. I thought I was safe.” Yet hours later he woke up in the hospital, lucky to be alive.

Highly potent drugs like these designer benzodiazepines are a growing trend among those seeking a new high, fueled in part by doctors overprescribing benzodiazepines without appreciating their addictive potential. Just as overprescribing opioids contributed to the use of heroin and illicit fentanyl and related deaths, overprescribing benzodiazepines may herald the dawn of a new era of illicit and deadly benzodiazepines.

Benzodiazepines work well to ease anxiety or insomnia when used intermittently and for less than a month at a time. When taken daily for an extended period of time, they stop working and can make anxiety and insomnia worse. Most doctors don’t realize how addictive benzodiazepines can be for some people and, because they don’t know better, prescribe them long term and without safety monitoring, like checking the prescription drug monitoring database. In addition to addiction and death, long-term use of benzodiazepines can also contribute to cognitive decline, accidental injuries, and falls.

There are safer treatments than benzodiazepines for anxiety and insomnia. These include behavioral interventions and long-term medications like selective serotonin reuptake inhibitors.

Part of this public health crisis can be solved by physicians adopting wiser prescribing practices. But the public can help, too. If you are struggling with anxiety or insomnia and go to see your doctor, be wary of accepting a prescription for a benzodiazepine — including Ambien, a close cousin of benzodiazepines that is also addictive and potentially deadly.

If you take a benzodiazepine every day, ask your doctor about helping you taper off of it. It’s important to go slowly, because abruptly stopping a benzodiazepine can precipitate life-threatening withdrawal. If you’re a parent and you notice a precision laboratory scale in your child’s bedroom or mysterious packages arriving from FedEx, get worried fast.

Anna Lembke, M.D., is associate professor of psychiatry and behavioral sciences at the Stanford University School of Medicine, chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, and author of “Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop” (Johns Hopkins University Press, 2016).

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  • I have safely used Klonopin for years to combat severe panic disorder. It is easy to monitor (for the patient) since you don’t get a “high” or “rush” from it. There is so much nonsense and bad “science” out there, mostly fueled by Big Pharma to sell SSRI’s and other junk, which, by the way, does NOT work on panic or anxiety. It is irresponsible for doctors to make these sweeping claims about the use of benzodiazipines which DO help when used as directed. Using the story of a patient who obtained some designer drug off the Internet as a cautionary tale is just a disservice to patients whose lives are often made far better and even possible (for those who are housebound by anxiety and panic). We patients deserve to know the truth as to who is REALLY behind this campaign against benzos; they are NOT the same as opioids. Do some research, doctor! Here’s a place to start:
    https://www.psychologytoday.com/us/blog/how-everyone-became-depressed/201306/benzo-hysteria

    • Thank you Sharon . I agree completely . I took a 1/2 gram pill of lorazepam for several years as a sleep and relax aid once a day at bedtime , never high , never addicted , and at mere pennies per dose.. It got me through a tough time. Was able to easily taper off when things improved . Your idea that Big Pharma and their doctor agents are just wanting to make more money off of opioids and SSRI’s is spot on.

  • Another physician promoting the Let’s Scare America tactic as one of the arsenal weapons of the War on Drugs. Never mind that the facts are distorted to fit the goal. As an associate professor, you’d think that Anna Lembke would be informed enough that she would choose not to participate as a member of a spineless, weaponized medical community, pursuing the government’s agenda to remove medical care decisions from the hands of the physicians. Benzodiazipines, as well as opiate pain medication, are extremely effective long term for treating their target conditions (pain, insomnia, anxiety), for some patients. In fact, opioids are THE time-honored and PROVEN go-to medication for treating pain. This idea of taking medications away from those who want to be saved in order to save those who don’t want to be saved is simply foolishness incarnate. Physicians should stop parroting what is politically correct just so they can gain approval from their brethren who are equally corrupt, and stop promoting unpredictable, dangerous and SSRIs that are not effective for treating pain, and have been clinically shown to be less effective than cognitive therapy mixed with exercise for treating depression.

    • Take a look at Traci Gregory’s June 1 post, then re-read the article. The fact remains that benzos and opioids are powerfully addictive drugs. I’m definitely not one to police anyone else; on the contrary, I think if marijuana were legal benzos and opioids wouldn’t be causing the problems we’re seeing today. And, frankly, IDGAF what anyone else does anyway. I think it should all be legal.

      That being said, Purdue Pharma told doctors for a long time that opioids were safe and non-addictive. I’m not an MD, and I bet a lot of docs are shitty people. I also know a lot of them are genuinely concerned about their patients and feel horrible about contributing to something they feel violates their oath (“first, do no harm”).

      You should be directing your ire towards Big Pharma, which did a great job of gaslighting the medical community, and the federal government, which refuses to re-schedule marijuana and MDMA (which has gobs of data showing its impressive utility as a psychotherapy adjunct, but that’s a different topic for a different day…). A few unscrupulous docs might have made a few $100k from prescribing opioids and benzos, but that’s nothing compared to the $BILLIONS made by Purdue, J&J and other pharmaceutical companies.

      In spirit, I’m on your side, but it’s really hard for me to agree with you when what you’re saying doesn’t make logical sense. #FollowTheMoney- it ain’t the family practitioners who are corrupt.

  • I have been on Xanax for almost 20 years.I have Afib and anxiety.I have NEVER increased my dosage and yes!the dose that I take every day works well for me.Please don’t take it away from people that aren’t abusers.

  • I hear you brother. It’s like a war on aspirin. I wonder what the motive is . Are they trying to deflect attention from their failures in dealing with opioids ??

  • We expect that an addiction physician would receive a call from an addict. An addict might easily seek drugs for entertainment from around the world. What does that mean to the formerly trusting, hard working and decent citizens who were assured that psych-drugs ( especially benzos) are benign. “Oh, only abusers will have a problem” we hear. We know this to be 100% false. We wonder why anyone would harm us to completely and still blame us for their own egregious behavior.

    The above post does not belong along side the desperate cries of the medically -abused.

    Will medicine ever be honest and warn patients of the persistent harm? I am sure that the answer is: “No”. It is up to us, those whose lives never will be whole again, to warn the world. Never believe those who benefit from the lie. Always seek primary sources of information. Your doctor is not a primary source of information.

    • I agree thousands injured with no warning taking my meds as prescribed and im a addict. Excuse me what they did to us was lie and its nothing short of MEDICAL GASLIGHTING! that form of abuse is illegal and punishable by law i believe. Its wrong. What do we do now that the drugs have caused severe brain damage and i cant leave my home? When will the doctors say im sorry we fucked up? When will i get to see my children again? Im mad and no trust in doctors.

  • C’mon.
    All of a sudden you understand this has been well known for 10 years.
    Sorry but Parents look in cologne boxes for pipes, look for candy or gum container including black film containers.
    Lastly, pee test your kid if you are suspicious but do NOT kick them out.
    If you can’t afford a private Dr. N many can’t go to the county health center. It’s not a character flaw it’s an addiction n to that the Dr.s should take all responsibility for getting us to where we are!! They are not called street drugs they have nick names…

  • I am glad to see this topic brought up. I was wondering about the people like myself that have taken my medication as prescribed for 9 years and now my doctor retired and im left in severe withdrawal, no one ever warned me about this while taking the clonazepam for 9 years. NO WARNING! I suffer so much torchure that I really wish i would die and the nightmare be over. Doctors dont believe me i have so many symptoms i cant leave my home I dont know what to do no one will listen so there is no hope ive exhausted my resources. Ty

    • @Traci — I am sorry this has happened to you, so sorry — please hang in there. I know a benzo cold-turkey is tortuous — I am in an isolated house-bound agony simply trying to taper. Don’t know how to cope.

      There’s medical help for heroin addicts but nothing at all for people injured by outright lies from the medical community. Instead we are treated like criminals … feel my life’s endeavors were all for nothing. Better they should have let me be on the benzo as it’s needed for my ability to like, ya know, live!

      Instead I must be “morally righteous” and remorseful for my “addiction” which actually allowed me to work and socialize. Take pride in the torture alive while truly dead, dreading the next moment and the next.

      God help us because no one else is doing a thing.

      I’m mad and I’m scared. I am praying for you.

      Sammi

  • 25 years ago my daughter began having panic attacks. Her doctor put her on Klonopin and for the next 25 years she has fought this horrible addiction. She never abused the medication. In fact she was obsessed with taking less than the prescribed amount. Some doctors over the years would change her medication, but they would only change it to another benzodiazepine. Her family has watched her health slowly deteriorate. She has been reclusive most of this time. In recent months she had difficulty with her balance and memory. She was losing her eyesight. Most of all she had to endure incredible pain.

    My daughter turned 50 on April 22, 2019. On May 8, 2019 she gave up her battle and took her life.

    Nothing will ever bring this most precious child back. I can only hope to find resources where I can help fight this dreaded disease. Please help me if you know where I might start.

    • I am so sorry to hear about your daughter. I can relate with her I attempted to take my life in 2014 on life support for 7 days. I can tell you the suffering from taking these stupid pills we did not ask for should be addressed. The sucicide needs to be talked about without judgement. People have lost everything and no one is being held accountable. I dont know where in any profession you can injure and kill so many and not be held accountable. Not even a apology. Its mental torchure but I refuse to stop fighting and see that ppl are held accountable for people like your daughter and myself because it has been kept silent long enough and its nothing short of medical gaslighting! Prayers and love to you and your family. My heart is with you. Continue to fight for her.

    • If you email me i can give you the information i have on lawsuit of benzodiazepine and not informing the patient of side effects and not following the national guidelines for prescribing.

  • So now they will take away people’s anxiety, panic snd ptsd insomnia medication. This nanny state mentality is total nonsense. Everybody has to suffer because of some who wanna party on and be like a retard rapper that glorifies drugs. Let nature work its magic on those people foolish enough to drink on these drugs and or mix 5 different cns depressants together. Most people know its risky but think they won’t ever drink on benzodiazepines. People who follow rules and dont misuse opioids and benzos suffer for the ones who do..bullshit. Another huge lie insurance and since a few years ago is never take opioids and benzos together. The two drugs can too be safely taken together even with soma if discretion is used.

    • If you know the risks, and you’re willing to take the risks; then you have the right to accept these drugs. The problem is that those who took as directed and ended incapacitated and in extreme pain did not know the risk of following their doctors’ orders. To make matters worse, the prescribers often claim “No Problem if taken as directed”. When the benzos actually hit the fan, the prescriber denies, denies, denies.

      Nanny State is not the problem. We don’t want the state to make decisions for us. We do want honesty. We STILL are not getting honesty. Instead we hear that normal people are not harmed by Benzos as long as these normal people are taking them for valid medical conditions. Really? The Benzo knows why you are taking it???

      How to people come to be benzo-damaged? By taking as directed.( It’s an incomplete sentence, I know, but it’s a true one.

      However, in my belief system, anyone who knows the risks should be free to take the risks. I don’t make rules for anyone.

  • Xanax destroyed my marriage. A doctor prescribed them to my husband for anxiety, and continued to prescribe it for 7 years. As he leveled out and couldn’t get a higher dosage, and injury made him learn that opiates (hydrocodone) gave him the feeling he originally had.
    He spiralled into terrifying addiction, in and out of detox, I had to give him chest compressions until ambulance arrived, etc.

    We were together for 10 years. He became a completely different man, I couldn’t recognize him, and the decline was very very rapid.

    Thank you for talking about this. My marriage, my happy life, was destroyed by both the opiate and the benzo epidemic. This shite is poison.

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