We might as well be living in the United States of Anxiety: Approximately 40 million American adults — roughly 18 percent of the population — have an anxiety disorder, and nearly 40 percent of the public claims to be more anxious this year than they were last year, according to a poll performed by the American Psychiatric Association.
This sudden rise in anxiety levels can be largely attributed to the contentious political climate — one in five respondents claim to be extremely anxious about the impact of politics on their daily life, and 36 percent are somewhat anxious about it. Americans are also talking about mental health more than ever before, which has almost certainly contributed to an increase in the number of people willing to admit that they suffer from anxiety in the first place. Celebrities like Demi Lovato and Selena Gomez have inspired some of this discussion by openly admitting to their ongoing struggles with anxiety, and earlier this year, the NBA engaged in a conversation about anxiety when Cleveland Cavalier Kevin Love confirmed that he suffers from an anxiety disorder.
But even more shocking than the massive portion of Americans currently teeming with anxiety is the number of Americans who have fallen victim to the medications that were supposed to be treating their disorders. Overdose deaths attributed to benzodiazepines (Xanax, Valium, Ativan, Klonopin) have risen sevenfold over the past two decades, according to a recent peer-reviewed essay appropriately titled “Our Other Prescription Drug Problem.”
But for most of us — especially those who suffer from anxiety — the question remains: Are benzodiazepines (aka benzos) inherently dangerous, and if so, what other options are available to help address our collective anxiety?
Let’s dive into this downward spiral.
Are benzos always dangerous?
The easy answer is, absolutely not: They can significantly (and safely) improve the lives of people who suffer from anxiety when used under the supervision of professional psychiatrists. “Benzodiazepines have been around for almost 60 years, and they’ve been used by millions and millions of Americans safely,” explains Timothy Fong, professor of addiction psychiatry at UCLA. “They’re FDA-approved for certain kinds of anxiety disorders, and they’re primarily supposed to be used short-term — for less than four weeks. There are some cases of treatment-resistant anxiety disorders, and in rare cases, people can be on these medications safely for years.”
But benzos are also extremely addictive — hence the short-term treatment periods — and our bodies adjust to them when taken consistently over long periods of time, meaning we eventually need higher (and more dangerous) doses to achieve the same effects. Fong estimates that approximately 20 percent of the patients admitted to his clinic on a yearly basis have developed some kind of pathological relationship with benzos. “They’re dependent, they’re addicted and their quality of life isn’t better because of benzodiazepines,” he says. “But they continue to take them despite those problems.”
This addictive quality becomes particularly dangerous when users begin taking both benzos and opioids at the same time, which is surprisingly common: More than 30 percent of deaths attributed to benzodiazepines also involve opioids, according to the National Institute on Drug Abuse, and the combination increases your risk of overdose fivefold (when taken together, the drugs can suppress your ability to breath).
The increase in overdose deaths attributed to benzos isn’t altogether surprising when you consider the fact that the number of adults being prescribed them increased by 67 percent — from 8.1 million to 13.5 million — between 1996 and 2013. And more than 17 percent of patients using opioids are also prescribed benzos at the same time, according to the National Institute on Drug Abuse, which (as we already explained) significantly increases their overdose risk.
At least some of these prescriptions, Fong believes, are written by under-trained physicians (who probably don’t provide psychotherapy or have the resources necessary to refer their patients to psychotherapists). “I just saw someone yesterday who was being prescribed Klonopin for the last 10 years,” he says. “I said to him, ‘Did your doctor ever tell you that this probably isn’t something you should be continuing on every month?’ The patient told me that he had no idea.” Fong also says that some doctors swiftly stop their patients from taking the benzos that they were prescribed when they begin to notice addictive tendencies, which throws the patient into withdrawal symptoms. “That’s certainly not good for anybody,” he emphasizes.
Making matters worse, Fong says that insurance companies have made it incredibly easy for doctors to hand out benzos: “Every single insurance company covers benzodiazepines without any sort of prior authorization or difficulty, and it’s because of that free, unfettered access that people have easily prescribed benzodiazepines and patients are very easily willing to take them.”
“Our Other Prescription Drug Problem” also mentions the growing problem of dangerous synthetic benzos manufactured in laboratories and sold on the internet without FDA approval or pharmaceutical oversight. “Clonazolam, an analogue of clonazepam [brand name Klonopin] that is akin to a combination of alprazolam [brand name Xanax] and clonazepam, is so potent that it needs to be dosed at the microgram level using a high-precision scale to prevent accidental overdose,” lead author and Stanford psychiatrist Anna Lembke writes. “It can be bought on the internet as a ‘research chemical’ and shipped virtually anywhere.” There’s also a chance that these synthetic benzos, which are often purchased for recreational use, may be tainted with the incredibly deadly synthetic opioid fentanyl.
Should we avoid benzodiazepines altogether?
The simple answer, once again, is definitely not. “We have a medication that works really, really well to quickly quell all of the flavors of anxiety: Generalized, specific, malaise, dread — you name it,” Fong says. “But then for some people (not everyone), if they continue to take them for long stretches of time, yes, they’ll develop problems. But for a large number of people, they can be on these things for years, occasionally using them every couple of weeks when they’re having a really rough day — and that’s totally fine.”
In fact, Fong notes that while the recent paranoia surrounding benzos is warranted, it may also prevent those who can truly benefit from these medications from getting the help they need. “I just had a patient today who has a profound anxiety disorder in the sense of PTSD and generalized anxiety,” he says. “She’s been on her medication consistently for the last 10 years — it hasn’t changed from low-dose benzos. Her doctor passed away, and she was having a difficult time finding a new doctor to prescribe her benzos. That’s a case where she should have been given benzos pretty easily.”
So what happens next?
“Our relationship with benzos as a nation is emerging to be very complicated: We love them, we hate them, we’re ambivalent about them and we’re dependent on them,” Fong explains. “Unless we have a larger discussion, more regulations and more science, there’s a potential for things to become worse. Why is that? Because we’re a nation under tremendous amounts of fear, stress and anxiety — and that’s not changing within the foreseeable future.”
L.A.-based psychologist and psychotherapist Jeanette Raymond agrees and attempts to provide some kind of solution: “Drug epidemics reflect the current angst among its users, when they can’t deal with their sense of helplessness and dread — their lack of hope,” she says. “So it’s about giving people a purpose that’s both intrinsically rewarding and allows them to feel empowered in taking care of themselves and others together. It’s not about banning drugs or using punitive measures, nor about using advertisements to scare them off. None of these work, because the strong need to manage impossible emotions overwhelms any other factor.”
In other words, our relationship with benzos will continue to be a complicated one until we collectively get our American shit together.