benzodiazepines prescription drug problem
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Americans have plenty of reasons to feel anxious these days and, in fact, more than 40 million adults in America do suffer from anxiety, the most commonly diagnosed mental condition in the country. There are drugs designed to treat anxiety, but they carry their own problems with them, and that's leading to rising concern among health professionals and mental health experts, who cite growing numbers of people addicted to and dying from these drugs.

The drugs are benzodiazepines, a class that includes such popular prescription drugs as Librium, Valium, Xanax, and Ativan. They are used not just for anxiety, but also for related syndromes such as phobias, panic attacks, and insomnia, and, according to a study from the National Institutes of Health, prescriptions for them increased by a whopping 67% between 1996 and 2013. Some 13.5 million adults filled a prescription for benzos that year.

That's at least in part because they work. Benzos help millions of people deal with contemporary life, and that can be the difference between maintaining under stress and flaming out. Even now, with concerns about side-effects on the rise, benzodiazepine prescribing guidelines, while emphasizing the inadvisability and dangers on long-term use, grudgingly concede that benzos are "effective in the relief of short-term but not long-term insomnia" and, while not first-line therapy, "may be used as an adjunct" in treating anxiety. The guidelines also recognize benzos' efficacy for "short-term relief of muscle discomfort."

There's a lot of stress going around. The general anti-anxiety disorder market, which also includes antidepressants, was worth $3.4 billion in 2014 and is expected to reach $3.8 billion by 2020, according to a Zion Market Research report. That buys a whole lot of pills.

But benzos are also killers, and they're killing more people than ever. According to the National Institute on Drug Abuse, benzodiazepine overdose deaths jumped nearly eight-fold in recent years, from 1,135 in 1999 to 8,791 in 2015. That's only a fraction of the more than 47,000 2015 drug overdose deaths reported by the Centers for Disease Control, but it's still thousands of dead people.

Benzos don't only kill people; they also get them strung out. They work by binding to GABA receptors in the brain and enhancing their function. GABA is an inhibitory transmitter, and benzos thus calm the brain down, but there's a price to pay.

"The brain basically compensates by downregulating its own internal mechanisms for calming the brain," Dr. Anna Lembke, chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, told CNBC in a recent report on the topic. "Ultimately, the individual becomes dependent on benzos to remain calm."

That's right: In a cruel twist, if you can't get access to the drugs you use to fight anxiety, you get even more anxious than before. That's why Lembke recommends no more than two to four weeks of daily use or limiting benzos to two or three times a week if using them long-term.

The benzos also have some nasty withdrawal symptoms, including increased anxiety, insomnia, depression, irritability or muscle jerks. And unlike opioids, withdrawing from a severe benzo dependency can kill you, typically through grand mal seizures. But the severity of the withdrawal depends on the type of benzodiazepine being used.

Dr. Wilson Compton, deputy director at the National Institute on Drug Abuse, told CNBC that short-acting benzos, such as Xanax, are known to cause more severe withdrawal symptoms, while longer-acting benzos, such as Librium and Valium, have less severe withdrawal syndromes.

"All of these medications can cause significant withdrawal when stopped abruptly after being used consistently for an extended period of time, he said. "That's why someone cutting back or stopping these medications needs medical supervision."

After nearly two decades of rapidly rising benzo prescribing, the medical community has taken note. Benzodiazepine prescriptions actually peaked in 2013 as doctors pulled back in the face of rising evidence of benzo-associated death and addiction, much as doctors did with prescription opioids in the face of the opioid overdose and addiction crisis. But that is creating its own problems, just as happened with opioids.

While legal prescriptions have declined over the past five years, people already dependent on them are finding other means of obtaining them. Now, smuggled, diverted, or fake benzodiazepines are appearing on the black market. Those carry all the risks of pharmaceutical benzos, with the additional risk factor of consumers not being sure just what they are consuming. Just as the crackdown on opioid prescribing led to a decrease in prescription opioid deaths and an increase in deaths from illicit opioids, such as heroin or unlicensed fentanyl, we are likely to see a decline in prescription benzo deaths, but a similar increase in deaths related to black market benzos.

Anxiety disorders can be devastating and disabling, but they can also be treated without resorting to benzos. Psychotherapy, particularly cognitive brain therapy is one approach, as is acceptance and commitment therapy, which teaches mindfulness and staying in the moment (as opposed to what author Michael Pollan calls "time travel"-brooding over the past or worrying about the future).


Comment: There are alternatives to medication for anxiety and insomnia:

Meditation, exercise, and good sleep regimes can also take the place of benzos. And if drugs are the best option, selective serotonin uptake inhibitors (SSRIs-Paxil, Prozac, Zoloft), used to treat both anxiety and depression, are a safer alternative, since they are typically not habit-forming, have less worrisome side effects, and seem to work better in the long run. Oh, and then there's medical marijuana, which recent studies suggest could help.