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Addiction to Legal Drugs: Prescription Painkillers and Benzodiazepines

Prescription drug misuse, abuse, and addiction is an ongoing problem in the United States. This includes prescription painkillers as well as benzodiazepines, like Xanax, Valium, or Klonopin. Prescription drugs are meant to be used under medical supervision, where check-ins and communication are important. However, this is clearly not fool-proof, even if medical professionals and patients are as diligent as possible. Many prescription painkillers and benzodiazepines carry a high risk for addiction. There is a high risk when both are used at the same time, with the CDC warning not to prescribe both at the same time if it can be helped. The National Institute on Drug Abuse (NIDA) found that more than 30 percent of overdoses that involved opioids also involved benzodiazepines. Further, the risk of overdose is 10 times higher when they are mixed, than when someone is only using opioids.

For a lot of people, there is an assumption that they will use prescribed, legal drugs safely and avoid addiction. Even people that are misusing legal drugs might have this assumption. The problem is that so many different factors involved can quickly change this. It’s possible someone’s genetics leave them susceptible to addiction, which they might not realize. While it’s easy to start out carefully using a prescription drug, dependence can creep up on someone before they realize it. At that point, addiction will start to change their behavior in ways that seem out of their control.

Opioids: Use and Side Effects

80% heroin users report they used opioids prior to heroin

Prescription opioids are primarily supposed to be used for pain relief. They can be used for diarrhea and coughing as well. They provide a feeling of relaxation, pain relief, and can produce a euphoric “high”. Common prescription opioids include hydrocodone, oxycodone, codeine, and morphine. According to NIDA, they work by binding to and activating opioid receptors in the brain, spinal cord, and other organs in the body. Subsequently, they block pain receptors and release dopamine into the body which helps to provide a pleasurable feeling. Many people quickly become dependent, which is where they begin to misuse prescription opioids. It’s important for anyone taking prescription opioids to taper off with medical supervision. Trying to do so on one’s own can prove difficult and even impossible for many.

Certain side effects include:

  • Drowsiness
  • Confusion
  • Nausea
  • Slowed breathing

It’s possible for withdrawal to set in as early as a few hours after last taking prescription opioids. Some withdrawal symptoms include:

  • Muscle and bone pain
  • Cold flashes
  • Severe craving
  • Anxiety
  • Flu-like symptoms

Often, the severity of withdrawal symptoms make it difficult or impossible for people to stop using prescription opioids without help. For a number of people, when they misuse opioids, and begin to develop dependence and addiction, they then turn to heroin. It’s easier to get and cheaper, with nearly 80 percent of heroin users reporting that they used opioids prior to heroin. At the point of dependence and addiction, it’s less about will-power and more about how the drug impacts the body. Withdrawal is uncomfortable and potentially dangerous, and at that point someone is not always thinking clearly.

It is possible to overdose on prescription opioids, and especially so if people combine with alcohol or other medications like benzodiazepines. They sometimes slow breathing, and if another substance also slows breathing the risk for overdose increases significantly. As our bodies adjust to certain medications, it’s possible we can develop a tolerance. From there, more of the substance is needed to feel the same effects we initially did.

Benzodiazepines: Use and Side Effects

Benzodiazepines (benzos) are a class of psychoactive drugs. They are primarily used to treat anxiety, seizures, and insomnia. Some of the common brand names include:

  • Xanax
  • Klonopin
  • Ativan

For the most part, benzos are meant for short-term use. This is partly due to the high risk for addiction. Benzos that are prescribed continually are usually done so in conjunction with antidepressants; this is partly from anxiety and depression commonly occurring together, but also that benzos can cause an increased risk of suicide. With some benzos, like Xanax, there is the risk of dependence or addiction within even the first week of use. Despite this, according to NPR, not only are benzo prescriptions increasing, the number of continued or long-term prescriptions are increasing as well. As mentioned above, benzos and opioids are frequently prescribed together, despite the significant risk that comes from both drugs.

Common side effects from benzodiazepines includes:

  • Drawsiness
  • Confusion
  • Depression
  • Headaches
  • Slowed breathing

With benzos, it is slowed breathing that is often one of the more dangerous symptoms particularly when mixed with other substances.

Benzodiazepine withdrawal is undoubtedly difficult for most people to go through on their own. This is likely why many people fail when they try to do so without professional, medical help.

withdrawal symptoms

Potential withdrawal symptoms include:

  • Sleep disturbances
  • Heart palpitations
  • Nausea
  • Muscle pain
  • Seizures
  • Psychosis
  • Hallucinations

These symptoms are not going to happen for anyone that stops using benzos. They’re more likely for people who have developed severe addiction and physical dependence.

Benzo overdose is possible, though not common just on its own, it is significantly more likely when combined with other substances. Polysubstance abuse, which is the abuse of 3 or more substances, commonly involves alcohol. Many people are prescribed or abuse benzos and opioids together, and they then add alcohol to the mix. It’s possible people are monitoring how much they are consuming, thinking if they limit the substances they will be safe. Benzos, opioids, and alcohol all can cause respiratory depression. The combination of all three is incredibly dangerous and it’s not necessarily always large amounts of each substance that is consumed in causing overdose. Frequently, when someone overdoses on all of these substances, or even just two, it appears that they are sleeping. Unfortunately, this makes overdoses hard to identify, without obvious evidence, until it is too late. It’s very possible someone is prescribed both benzos and opioids without realizing the danger, use them responsibly, and still are at risk for overdose.

Factors Behind Prescription Drug Abuse and Addiction

Addiction is a complex process and understanding the many causes behind it is just as complex. There is still a need for a lot of research to be done, but we are beginning to understand how the opioid crisis and addiction to other prescription drugs has risen the way it has. Part of it was ignorance regarding addiction and how these drugs impact people. Further, for many prescriptions drugs, regulation has been inconsistent and inadequate. Many of us have trusted that prescription, legal drugs are safe and would not cause addiction the way it has.

NIDA explains, “In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates.” This flooded communities with opioid prescriptions and increased the opportunity for misuse. Similarly, benzo prescriptions have continued to rise in the United States in conjunction with opioid prescriptions. It’s possible they’re prescribed for pain, but also that someone is dealing with anxiety, insomnia, or other health concerns that benzos are meant to treat. An NPR study found that prescriptions are often filled by primary care doctors, who may not have adequate training when it comes to prescribing multiple drugs that have a high risk for addiction.

Treatment

Prescriptions drugs like opioids and benzodiazepines are supposed to be helpful, and often only meant to be used short-term. However, they clearly have a high risk for addiction. The over-abundance of prescriptions has created a lot of opportunities for misuse and abuse. Some people do intentionally misuse substances from the start. However, a number of people are legally prescribed drugs, which they plan to use as intended. It’s possible that many have genetic vulnerabilities that leave them susceptible to addiction. Whatever the case, it’s important for drug rehab centers to look at all of these possible factors to determine the best course of treatment. Furthermore, it’s significant to know that someone can misuse and abuse opioids and benzos without having a full-blown addiction. There’s still potential for the abuse to have an impact in their life and cause problems. If it’s possible to recognize the problem before it gets even worse, then there will be a significant advantage.

Prescription medications are not all inherently bad, but many people may want and need alternative ways to learn how to feel better. At Mountain View Recovery, we understand that it’s important to have a comprehensive understanding of each patient. This means taking a patient’s entire life into consideration. Physical and mental health are impacted by many things in one’s life. For a lot of people, trauma is a part of their addiction whether it occurred before or during, or both. Eye Movement Desensitization and Reprocessing (EMDR) and Somatic Therapy are two types of effective therapy in dealing with trauma. We also believe in adventure-based therapy. This helps patients recover by connecting with nature, learning survival skills, and accomplishing new things.