January 5, 2024

The growing opioid crisis, now in its fourth wave, has created serious repercussions for drug courts. But within this crisis, the second most deadly class of drugs, known as benzodiazepines, are causing even greater issues. The growing prevalence of juvenile benzodiazepine abuse has resulted in a fatal intersection of polysubstance use, where a large portion of opioid-related deaths is connected to benzodiazepines.

These familiar drugs have been used for decades to combat anxiety and epilepsy, but they have always carried potential risks with prolonged or inappropriate use. Now, with the explosion of illicit opioids on the black market, benzodiazepines have become more dangerous than ever.

What Are Benzodiazepines?

Benzodiazepines, also known as benzos and BZDs, are a class of psychoactive drugs commonly used for both their physical and psychological effects. Benzos have been widely available for prescription use since the 1960s, but their use increased dramatically between 2008 and 2015.

Medical Indications

Benzodiazepines are typically prescribed for conditions like anxiety, panic disorders (including PTSD), seizures, sleep disorders, and insomnia.

  • Alprazolam (Xanax): used for anxiety and panic disorders
  • Clonazepam (Klonopin, Rivotril): used for epilepsy and seizure treatment
  • Diazepam (Valium, Diastat): used for anxiety, muscle spasms, and seizures
  • Lorazepam (Ativan): used for anxiety, seizures, and epilepsy
  • Oxazepam (Serax): assists with alcohol withdrawal
  • Temazepam (Restoril): used for insomnia
  • Triazolam (Halcion): used for insomnia

Benzodiazepines should be prescribed for short periods only, generally in the time frame of days or weeks. These uses, however, differ for adolescents.

Effects

Benzodiazepines increase dopamine production in the brain, resulting in increased sensations of relaxation and calm. They are also muscle relaxants, which is why they are commonly used for seizures, muscle spasms, and epilepsy. Their fast-acting effects have made them a go-to drug for specific anxiety triggers (flying, public speaking, etc.).

Dangers and Side Effects

Short-term use of this drug class can be beneficial, but chronic benzodiazepine use has been linked to several negative and dangerous side effects. These side effects are magnified in teens and adolescents, making juvenile benzodiazepine abuse a serious concern. Some of the observed side effects include:

  • Depression
  • Early-onset Alzheimer’s disease
  • Memory loss and memory issues
  • Early death
  • Substance use and abuse
  • Addiction

The Increasing Dangers of Juvenile Benzodiazepine Abuse

From 2008 to 2015, prescriptions for benzodiazepines dispensed for juveniles saw a relatively steady increase. Overall, the trend was the same for young adults. In 2013, however, that trend appeared to reverse, as both adolescent and young adult prescriptions decreased per capita. Despite this trend reversal, the overall number of benzodiazepines prescribed in 2019 was still higher when compared to 2008.

Fewer Prescriptions, More Deaths

Even with an overall per-capita decrease, BZD-related overdose deaths nearly doubled from 2010 to 2021. Closely correlated to this increase is the prevalence of illicit fentanyl. Over that same period, fentanyl-related overdose deaths saw a 2,326% increase. And in benzodiazepine-related overdose deaths, synthetic opioids (primarily fentanyl) were frequently present as well.

The Problem with Adolescent BZD Prescriptions

According to a study performed by the JAMA Network, physicians have seemingly scaled back prescribing benzodiazepines to teens and adolescents, but there is still a problem with how they are being prescribed. In their 2021 study, only 25% of diagnoses corresponded with an approved indication for a benzodiazepine within this demographic.

Long-Term Use Issues

Benzodiazepines are also commonly prescribed for several months at a time. This drug class, however, is only indicated for short-term use (a few days to a few weeks). Extended use leads to a higher likelihood of abuse and dependency, contributing to both use and withdrawal complications.

The Effects of Juvenile Benzodiazepine Abuse

Drug use comes with serious consequences at any age, but juveniles are at an even greater risk of developmental, mental, and physical health issues due to substance use and abuse. This is true for benzodiazepine abuse as well since this class of drugs comes with dangerous side effects and long-term consequences that could impact several areas of brain development.

Physical and Psychological Addiction

Benzodiazepines are both physically and psychologically addictive. Their effects on endorphins within the brain, specifically dopamine, create feelings of sedation, relaxation, and euphoria. But as the dopamine receptors become fatigued from the increased rush of this chemical, users experience more tolerance, resulting in the need for higher doses of benzos.

Memory and Neuroplasticity Issues

A particularly concerning connection exists between benzodiazepine use and early-onset Alzheimer’s Disease. While this effect is generally within older populations, long-term use of BZDs at any age has been linked to memory issues. Other studies have shown that neuroplasticity may be impaired due to the effects BZDs have on various mRNA transcripts.

Increased Risks with Polysubstance Use

Used alone, benzodiazepines can be dangerous. However, when combined with opioids or alcohol, the risk of accidental death increases drastically. As of 2021, 70% of all benzodiazepine-related deaths include the use of opioids.

Extreme Withdrawals

The short-term use recommendations for benzodiazepines relate to the addictive properties of this drug class, but they are also influenced by the severe withdrawal symptoms that come with extended use. These symptoms can include:

  • Headaches
  • Fatigue
  • Extreme pain and body aches
  • Restlessness
  • Hallucinations
  • Nightmares
  • Insomnia
  • Panic attacks
  • Suicidal thoughts

These withdrawal symptoms are long-lasting, and they become more extreme the longer an individual has used BZDs.

PharmChek® for Juvenile Drug Courts

See how the PharmChek® Drugs of Abuse Patch changed the way Yuma County's juvenile drug court helped youth recover from drug use and abuse.

Safeguarding Youth from BZD Abuse

Knowing the dangers of juvenile benzodiazepine abuse, along with the availability of these drugs, makes it a pressing issue in drug courts that serve adolescents and teens. There are three key areas that these courts can focus on to help young adults avoid benzodiazepine abuse and recover from misuse and addiction: security, support, and accountability.

Keeping Prescriptions Secure

BZD abuse is often connected to prescription accessibility. Whether from parent prescriptions or their own, juvenile benzodiazepine abuse can be prevented when these substances are properly secured and monitored.

Support and Accountability

Addressing juvenile BZD abuse takes careful support and consistent accountability. Teens who need to recover from addiction will need oversight and potentially even medical assistance to endure the withdrawal symptoms and effects, especially if they are chronic users. It will also take consistent efforts for court officials to help maintain sobriety and avoid relapse.

While observation is a major part of this accountability, drug courts will likely need methods like drug testing to prove sobriety and provide feedback for improved treatment techniques. One such drug testing system that many juvenile courts have found valuable is the PharmChek® Drugs of Abuse Patch.

Benzodiazepine Drug Testing with PharmChek®

PharmChek® now provides benzodiazepine screening and confirmation in its expanded panel. This additional detection provides drug courts with the tools they need to detect BZD use, take action for both positive results and relapses, and provide better accountability for their participants.

With 24-hour sample collection and a tamper-evident design, the PharmChek® Sweat Patch offers a more comprehensive picture of the donor’s use patterns without inhibiting their ability to maintain compliance. And our commitment to accuracy ensures that results are dependable and court-admissible for every confirmation. Contact one of our sales representatives to find out more about our updated standard and expanded panels, our fentanyl add-on, and our testing and confirmation to see what PharmChek® can do for your juvenile drug court.