Many mental health medications walk the line between helping those who need them and harming those who don’t. Benzodiazepines pose a risk of addiction, withdrawal, and misuse, but when taken appropriately, they reduce anxiety, can aid sleep, and help with symptoms of seizures. It’s important to know the facts about benzos in order to make an informed decision for yourself and your situation. Below, we’re outlining benzodiazepines, a brief history and controversy, benefits, risks, and overdose potential.
What are benzodiazepines?
Benzodiazepines, or “benzos,” are a family of drugs that slow or “depress” the body’s central nervous system activity. This effect is helpful when treating seizures, anxiety, and insomnia. You may be familiar with famous— or infamous— members of this family: Xanax® (alprazolam), Klonopin® (clonazepam), and Rohypnol® (flunitrazepam, also known as “roofies”).
Benzos are one of the most prescribed drugs in the United States. They are a Schedule IV controlled substance. While widely prescribed, they come with a history of controversy.
Why are they controversial?
Before benzos came onto the market in 1960, there was a class of drugs called barbiturates. They had a small therapeutic range and a high risk of overdose. Companies were on the hunt for a safer sedative with a lower overdose risk. In 1955, Leo Sternbach created the first benzodiazepine, Librium® (chlordiazepoxide).
As benzodiazepines were considered safer than barbiturates, some of their side effects went underemphasized. Many consumers taking these medications long-term were unaware of the associated withdrawal symptoms and addiction potential of some benzodiazepines. In 1979, a U.S. Senate hearing led by Senator Ted Kennedy was held to investigate the dangers and widespread use of Valium® (diazepam), then the best-known benzodiazepine.
Additionally, benzodiazepines have been involved in sexual assault cases. You may have heard of Rohypnol® or “roofies,” also known as the “date rape drug.” Rohypnol is not approved for medical use and is illegal to possess in the United States.
Why would someone be prescribed a benzodiazepine today?
The medication class of benzodiazepines does have benefits for the right person in the correct setting. They are typically only prescribed for short-term use. Their effects are relatively fast-acting. This is a very helpful feature, depending on the circumstance.
Benzodiazepines act in a variety of different ways, including the following:
- Amnestic: They block the formation of new memories, and are typically used in dental settings or medical procedures before anesthesia.
- Anxiolytics: They can be used to treat anxiety disorders and panic attacks
- Anticonvulsants: Benzodiazepines can be given during or after a seizure under medical supervision to help with abnormal nerve firing.
- Antispasmodics: They can reduce muscle spasms, leading to muscle relaxation.
- Hypnotics: Derived from the Greek word “Hypnos,” meaning “sleep,” benzodiazepines can help treat insomnia by providing a strong sedative effect.
- Sedatives: They can slow down brain activity for a calming effect. This is a shared quality among most benzodiazepines.
If someone is having a panic attack, an anxiolytic may provide fast relief. In comparison, other medications (like a Selective Serotonin Reuptake Inhibitor (SSRI)) may take several weeks to months to have therapeutic value.
Clinical guidelines for the length of use for most benzodiazepines are 2-4 weeks. Afterwards, there is a chance of building up a tolerance and experiencing withdrawal symptoms after stopping use. It is common to develop a tolerance to their sedative effect, which can defeat the purpose when treating something like insomnia.
Two factors are at play in a prescription: strength and duration of use. If long-term use is necessary, a prescriber may opt for a low-strength benzodiazepine. The duration someone is on these drugs depends on their medical condition.
These drugs may be addictive. Physicians try to avoid prescribing benzodiazepines for patients with a history of substance abuse. However, sometimes the benefits outweigh the risks, such as when Librium® (chlordiazepoxide) is used to treat alcohol withdrawal symptoms.
Benzodiazepines Side Effects
These fast-acting drugs have a few side effects, including:
- Drowsiness
- Dizziness
- Loss of coordination or balance
- Blurry vision
- Confusion
The sedative effects of benzos become dangerous when mixed with substances like alcohol or opioids. Never mix benzodiazepines with other prescription medications unless you’ve spoken with a trusted medical provider.
Benzodiazepine Withdrawal
It is possible to experience withdrawal symptoms after stopping or reducing the dose of the prescribed benzodiazepine. This may happen when taking the medicine beyond the 2-4 week recommended timeframe. However, withdrawal symptoms depend on the person, dose, drug type, and length of time taken. It is important to speak with a healthcare provider before discontinuing use.
Some symptoms of withdrawal include:
- Sweating
- Shaking
- Muscle spasms
- A resurgence of anxiety or insomnia
- Nausea and vomiting
- Heart palpitations
- Difficulty concentrating
- Memory problems
- Irritability
- Emotional numbness or depression
Severe withdrawal symptoms may occur in the case of abuse or long-term benzodiazepine use. Seizures are the most concerning symptom.
How do benzodiazepines work?
There is a neurotransmitter in your brain called gamma-aminobutyric acid, or GABA. It’s in charge of calming the central nervous system(CNS). When benzodiazepines enter the body, they help GABA bind to the GABA receptors more than they normally would, thus effectively quieting the nerve cells.
Nerve signaling slows down, which means your motor functioning and reaction time are also slower. Therefore, it’s not safe to take benzodiazepines and drive a car or operate heavy machinery. It is also not recommended to take these drugs while pregnant unless otherwise directed by your healthcare provider.
With all this sedation, it’s easy to see how combining a benzodiazepine with another sedative, like alcohol or an opioid, could be harmful. The nervous system response is slowed far more than a benzodiazepine would do on its own, with the correct dosage.
Signs of a Benzodiazepine Overdose
Benzodiazepine overdose is possible if they are misused or combined with other medications. By following your prescription instructions, you can keep yourself safe.
Call 911 immediately if any of these symptoms occur:
- Slow or shallow breathing
- Unresponsiveness
- Slurred speech
- Blue-ish tint around the mouth or fingernails
Final Thoughts: How to Prevent Misuse
There are a few ways to keep yourself and your loved ones safe from benzodiazepine misuse:
- Follow prescription instructions exactly.
- Lock prescriptions away in a container that reduces access to children and teens.
- Dispose of unused medications properly.
If you have any questions about benzodiazepine use and safety, call the Missouri Poison Center at 1-800-222-1222. We are open all day, every day for any poison-related question. Every call is confidential, and we can help connect you to the right resources.
If you or a loved one accidentally swallowed more benzodiazepines than intended, call us right away.
If someone you know is short of breath, unresponsive, or having a seizure, call 911.
Frequently Asked Questions
Yes. Xanax® (alprazolam) is a fast-acting benzodiazepine commonly prescribed for anxiety and panic attacks. Like all benzodiazepines, it should be used as directed to avoid dependence or withdrawal.
Non-benzodiazepines, sometimes called “Z-drugs,” are sleep medications that act on similar brain receptors but are structurally different. Examples include zolpidem and zaleplon. They also carry risks and should only be taken under medical guidance.
Older adults may be more sensitive to benzodiazepines and can experience increased drowsiness and falls. Providers often use lower doses or consider alternative treatments when possible.
Most benzodiazepines begin working within minutes to an hour, depending on the type and dose. This fast onset is helpful for sudden symptoms but also increases the risk of misuse if not taken as directed.
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Suggested APA citation:
Missouri Poison Center Trending Topics Blog. (2025, December 23). Benzodiazepines: Uses, Risks, and Overdose. Missouri Poison Center. https://missouripoisoncenter.org/benzodiazepines/