Every year, millions of benzodiazepine (benzo) prescriptions are filled across the country to treat anxiety, seizures, and insomnia. Of the many people who use benzos, be it as a part of treatment, self-medication, or recreational use, an estimated 44% become dependent on them at some point.
Because benzo prescriptions are so widespread, we are often blindsided by both the harmful side effects of long-term use and the devastating challenge of withdrawal. These drugs cloud the mind, making it difficult to hold on to jobs and relationships. They are also acutely harmful to the body, with evidence linking benzodiazepine addiction to permanent cognitive impairment, Alzheimer’s disease, and premature death.
Withdrawing from benzo dependence is a complicated process regardless of whether you are phasing out of medical treatment or recovering from addiction. Detox programs in substance use treatment facilities like ours exist to make this process safe, comfortable, and permanent.
What Are Benzos?
As a category of drugs, the benzodiazepine family is relatively large and diverse. These central nervous system depressants are listed under Schedule IV of the controlled substances act by the Drug Enforcement Administration (DEA) but remain commonly prescribed, frequently misused, and unfortunately addictive.
When we talk about benzos, we are talking about dozens of different medications, each with their own characteristics and reasons for being prescribed.
The most common types of benzos are:
- Alprazolam (Xanax)
- Chlordiazepoxide (Librium)
- Clonazepam (Klonopin)
- Clorazepate (Tranxene)
- Diazepam (Valium)
- Estazolam (Prosom)
- Flurazepam (Dalmane)
- Lorazepam (Ativan)
- Midazolam (Versed)
- Oxazepam (Serax)
- Temazepam (Restoril)
- Triazolam (Halcion)
- Quazepam (Doral)
Benzos in the Body
Benzos are most frequently taken orally. They are lipophilic and pass easily beyond the blood-brain barrier and into the central nervous system. Here, they take effect quickly by interacting with specific brain cell proteins called gamma-aminobutyric acid (GABA) receptors.
These receptors are key chemical pathways that enable our nervous system to modulate its own activity. In the simplest terms, GABA is a neurotransmitter that produces sedative effects across our brain, reducing messages, physiological functions like heart rate, and anxiety. Benzos amplify the effects of GABA while they are in our bodies.
However, as with all foreign toxins, benzos don’t stay in your system forever. They are slowly processed out from the bloodstream by the liver and broken down into their component building blocks or metabolites.
For some types of benzos, breaking down the original chemical brings an end to its psychoactive effects. Still, others, such as diazepam, have active metabolites, which stretch out the period of influence.
Dependence and Withdrawal
Prolonged use or misuse of benzos can lead to chemical dependence – this means that the nervous system has adjusted its functioning to assume the presence of these drugs or their metabolites. Quitting benzo use in these cases can lead to the development of benzodiazepine withdrawal syndrome.
Symptoms of withdrawal include:
- Sleep disturbances
- Panic attacks
- Deep muscle pains
- Shaking and tremors
- Loss of concentration
- Memory problems
- Nausea and dry retching
- Rapid weight loss
- Heart palpitations
- Suicidal ideation
Unlike some other drug abuse withdrawal syndromes, benzo detox symptoms do not simply taper off on their own. These symptoms come in waves that are difficult to predict and even harder to cope with.
Unassisted detox is risky. If you have reason to believe that you or a loved one has developed a physical dependence on any category of benzo drug, reach out to a qualified admissions representative at a licensed treatment center.
How Long Do Benzos Stay in Your System?
The different formulations of this type of drug were all created for various purposes, to treat very different symptoms, for example. Some start acting and climb towards peak levels almost immediately, while others slowly release and build up in the system over several days.
Because of this, there is no hard-and-fast rule for the length of time it takes for a dose to be entirely eliminated from a person’s system. However, you can make a broad estimate based on which subcategory (short-acting, intermediate-acting, or long-acting) the specific drug you have been using falls into.
These subcategories are just descriptions of the biological half-lives of the various types of benzo. In other words, these categories describe the amount of time it takes for half of the initial dose of the drug to be eliminated naturally by the body in lab tests.
And what about the rest? Half-lives decay exponentially. This means that every time the initial half-life period passes by, the amount of the substance in your body cuts itself in half again. If the half-life of a drug is one hour, it would be down to 25% after two hours. However, for our intents and purposes, it takes about five half-lives for a benzo to be effectively eliminated.
Short-acting benzos have the shortest half-life. These compounds take between one and 12 hours to be halfway eliminated by your body’s natural processes, while the most persistent of them takes up to four days to disappear completely.
The most common short-acting benzodiazepines include:
- Triazolam (120 minutes)
- Midazolam (two to six hours)
- Alprazolam (six to 12 hours)
- Oxazepam (four to 15 hours)
- Temazepam (eight to 22 hours)
Because every individual metabolizes substances differently, intermediate-acting benzodiazepines are the vaguest to define. However, these sedatives normally take between 12 and 40 hours to decay by half and up to a week to be undetectable.
Common generic formulations include:
- Bromazepam (10 to 20 hours)
- Lorazepam (10 to 20 hours)
The longest-acting benzodiazepines typically take up to two days to reach the first period of their half-life. After this, it can take two weeks for them to be fully eliminated.
Common versions include:
- Clobazam (12 to 60 hours)
- Clonazepam (18 to 50 hours)
- Diazepam (20 to 100 hours)
- Flurazepam (two point three hours, lasting metabolites 47 to 100 hours)
A few other factors complicate the length of time an actual drug and its metabolites stay in your system. The drug’s half-life in your body, as well as the ability of any specific screen to detect the substance, is affected by all of the following:
- Dosage amount
- Mode of ingestion
- Health status
- Kidney function
- Liver function
- Body mass
- Presence of other drugs
- Other medical conditions
Drug Testing for Benzodiazepines
Being asked to undergo drug testing is an everyday fact of life here in the United States. The most frequent reason why is employment – many organizations ask new employees to attend their headquarters for drug detection as part of their intake process.
Court cases and other encounters with the legal system often require drug tests, particularly when they relate to child custody or parole. Involvement in athletic organizations and participation in some sports competitions might also demand drug tests as a prerequisite.
Types of Tests
Regardless of the reasons for testing, it is important to understand that benzos and their metabolites can be detected in many of these tests for some time after cessation. The timeframe for how long depends on the type of benzo (short, intermediate, or long-acting) and the type of test sample.
When the body metabolizes a drug, the molecules it breaks into then spread and remain throughout the body. Many organizations will employ more than one type of drug test because of the variability of detectability for different drugs in diverse samples.
Most people going through routine screening will only have to provide samples for a blood and/or urine test.
Benzo Detection in Urine Tests
Urine tests are among the least non-invasive and most cost-effective screening options. This type of test measures the metabolites filtered into the urine when the sample is collected.
Benzo formulations that set in quickly can be detectable in urine samples within minutes of taking a dose. After this, metabolites can lead to a positive result in samples taken up to two weeks of the last use in most cases.
In the most extreme cases (Valium, for example), a urine sample can test positive even one month after the last use. The exact time frame of each benzos detectability in urine is closely related to the half-life of the particular drug.
Occasionally, alprazolam, clonazepam, temazepam, and triazolam may appear as false negatives, but almost every type of benzo is easily screened for using a urine test.
Benzo Detection in Saliva Tests
Saliva testing is another standard and non-invasive procedure for drug screens. A Q-tip sample is taken from either inside the cheek or under the tongue to check for substance abuse.
Benzos of all types can be very accurately tested for in oral fluid in the first hours after use, but this effectiveness drops off quickly. Saliva screens are only accurate within the first two to three days after the cessation.
Benzo Detection in Hair Tests
Hair follicles absorb benzo metabolites as they grow, and this dead matter is capable of holding them for a long time after stopping. Hair tests can accurately determine drug use up to 90 days after use regardless of the elimination half-life of the substance taken. This makes hair testing one of the most effective forms of screening. However, it is also one of the least common.
A hair follicle does take some time to grow, so to test positive, benzo use has to start at least five days to a week before the test sample is provided.
Benzo Detection in Blood Tests
The final potential detection method is the blood test. Blood testing can detect benzos in a person’s system for up to 24 hours after their last use.
This is by far the most invasive type of detection and is generally avoided due to the higher associated discomfort and the narrow window associated with an accurate test. Benzodiazepines stay in your system for far longer than the period required for blood tests.
While they are not frequently used for routine screens, blood tests are occasionally called for in medical situations when an individual is impaired or unconscious to replace other types of drug screens.
Addiction Treatment for Benzodiazepines
If you or a loved one has been using benzos frequently for an extended period, quitting and weathering withdrawal is not easy alone. Benzos have the potential to stay in the body for weeks, leading to a protracted withdrawal period and uncomfortable, potentially life-threatening symptoms.
Sobriety from benzos is the best choice you can make for your long-term physical and mental health, and the process of quitting should not put anyone in danger.
Choosing to detox and receive professional addiction care in a licensed treatment facility allows you to stay safe during the crucial period and build the foundations for a successful recovery.
To find out more about addiction treatment, contact us today.