Benzodiazepines, more commonly known as benzos, are a mainstay of pop culture. From cameos in movies and TV shows to that Billie Eilish song about Xanax, benzos have long been the drug of choice for Americans dealing with ever-worsening anxiety.
There’s one problem, though: Benzos can be dangerous.
“The risk-benefit profile of benzos for treating things like an anxiety disorder or insomnia is pretty poor,” says Dr. Andrew Saxon, an addiction psychiatrist in the Department of Psychiatry and Behavioral Sciences at the UW School of Medicine.
What he means is that, in many situations, the risks of taking benzos are greater than the potential benefits. Yet benzos remain one of the most-prescribed medications in America. As of 2018, more than 1 in every 8 U.S. adults was taking one.
Which prompts a question: If benzos are dangerous, why are so many people taking them? Here’s what you need to know.
How benzos work
Benzodiazepines have been around since the 1960s. Valium was an early option, but now brands like Xanax, Klonopin and Ativan are more popular.
The drugs are sedatives, so they calm you down and make you feel sleepy — kind of like alcohol. They do this by spurring activity among a neurotransmitter in the brain called gamma-aminobutyric acid (GABA), which slows down processing in the brain and nervous system.
This slowing-down happens very quickly, meaning if you’re anxious and pop a Xanax, you’ll feel better within the hour — sometimes even within minutes.
“That’s the seductiveness and allure of benzos, they honestly do work extremely well to calm people down and eliminate anxiety in the short term,” Saxon says.
Therein lies the biggest problem with them, though.
Why benzos are overprescribed
Anxiety is one of the primary problems benzos are used to treat — and it’s on the rise in the U.S.
According to the National Institute of Mental Health, anxiety disorders are the most common form of mental illness, with an estimated 19% of Americans experiencing one within the past year.
Benzos are also commonly prescribed for insomnia, which affects up to 30% of the U.S. population.
Aside from having a diagnosable anxiety disorder or other issue, there are many other people who go through periods of high anxiety due to life changes like divorce or the loss of a loved one.
Anxiety, insomnia and significant stress are, at the least, uncomfortable to experience — at the worst, they can be debilitating.
It makes sense, then, that many people experiencing one of these issues will try to find a way to manage it. Though there are several options, benzodiazepines often seem like the most promising. Who doesn’t want a quick fix that actually works?
This expectation comes into play when doctors prescribe benzos, Saxon says. If someone goes to the doctor because they’re feeling anxious or can’t sleep, they often want a solution right away. And doctors want to help. Benzos seem like an easy solution.
The dangers of benzos
The first problem with benzodiazepines is what makes them so effective: they work very quickly. If you’re feeling anxious, and then you take a benzo and almost immediately feel better, chances are you’ll want to recreate that chain of events the next time anxiety pops in for a visit.
But the more you want to recreate that feeling, the less you’ll actually be able to.
If someone takes a benzodiazepine on multiple occasions, their body begins to develop tolerance to it. Which means they next time they take the medication, it won’t work as well unless they take a higher dose.
This is particularly true of Xanax, which Saxon says he never prescribes.
“I don’t think it should be on the market. It rapidly absorbs into the brain, the effects are very potent, and if people like that, they’re going to feel good on it and want to have that effect again. On the other side of the coin, it’s very short acting,” he says.
Because of benzos’ calming effects and peoples’ desire to get more of it, some people end up overdosing. This usually isn’t life-threatening but can be extremely unpleasant, involving things like blurred vision, slurred speech, dizziness and confusion.
While overdosing on a benzo alone isn’t fatal, it can be if combined with other drugs, particularly opioids. In fact, according to the National Institute on Drug Abuse, at least 30% of opioid overdoses also involve benzodiazepines. This can happen when a patient who has a condition like chronic pain and is prescribed opioids presents with anxiety or insomnia and doctors prescribe a benzo, too.
Even without overdosing, taking a benzo often becomes a vicious cycle of craving that feeling of blissful calm but being increasingly unable to attain it.