Midazolam addiction: causes, symptoms, treatments, and risk factors

Midazolam addiction refers to a condition where individuals develop dependence on the short-acting benzodiazepine known as midazolam. This medicine, which is marketed under the trade name Versed among others, is frequently used for sedation, anesthesia, and the treatment of seizures and anxiety.

The causes of midazolam addiction are prescription dosage and duration, genetic factors, psychological factors, environmental factors, tolerance development, self-medication, and avoidance of withdrawal. 

The symptoms of midazolam addiction include intense cravings for the drug, drowsiness, memory loss, aggression, and headaches.

The treatments for midazolam addiction involve detoxification, cognitive-behavioral therapy (CBT), medication-assisted treatment (MAT), gradual tapering, support groups, dual diagnosis treatment, and aftercare and relapse prevention. 

FInally, the risk factors for midazolam addiction include a history of substance use disorder, long-term or high-dose prescriptions, lower socioeconomic status, network of individuals misusing benzodiazepines, and a history of abuse.

What is Midazolam addiction?

Midazolam addiction is characterized by the compulsive and harmful misuse of the benzodiazepine midazolam, a medication renowned for its sedative and anxiolytic effects. 

Primarily prescribed for procedural sedation, anesthesia, and the treatment of anxiety and seizures, midazolam becomes addictive when individuals misuse it, leading to dependency and adverse consequences. 

This addictive behavior falls within the broader spectrum of benzodiazepine addiction. Individuals grappling with midazolam addiction experience symptoms such as an increased tolerance, persistent cravings, and continued use despite adverse consequences.

How addictive is Midazolam?

Midazolam carries a high addiction potential, and the likelihood of developing an addiction to this benzodiazepine is significant. In fact, this is why as per the 2020 FDA news release titled, “FDA Requiring Labeling Changes for Benzodiazepines,” benzodiazepine products such as midazolam are expected to have warnings in their medication guides and prescribing material.

These warnings include information about the risks of misuse, physical dependence, abuse, withdrawal symptoms, and addiction that are present with midazolam. Moreover, a 2020 study by Ikram et al., published in the Pakistan Journal of Pharmaceutical Sciences stated that even with its wide range of clinical and therapeutic applications, midazolam becomes addictive after repeated doses.

What is another name for Midazolam addiction?

Another name for midazolam addiction is Versed addiction. The brand name, Versed, is primarily used in marketing and commercial aspects, serving as a distinctive label for the product. 

It is the brand name specifically given to the drug by the pharmaceutical company that manufactures it. On the other hand, the generic name, midazolam, denotes the chemical name of the drug and is used universally to identify its pharmacological composition. 

While both names represent the same medication with the same therapeutic properties, the generic name, midazolam, is more widely recognized in medical and scientific contexts, providing a standardized way to refer to the drug across different formulations and manufacturers.

How common is Midazolam addiction?

Midazolam addiction has increasingly become more common, findings of different studies suggest. For instance, a study by Frits Van Griensven et al., published in the June 2005 issue of the International Journal of Drug Policy documented an increase in self-reported midazolam injections over the preceding half-year, specifically from around 10% in 1999 to 31% in 2000.

Findings from a 2010 study by Kerr et al., published in the Harm Reduction Journal show that of the 252 individuals who use injectable drugs (IDU), 170 (67.5%) said they had injected midazolam at some point in the past, and 144 (57.1%) said they had done so every day for the previous six months. The study documented a significant prevalence of midazolam injections among Thai IDU. Midazolam injection was most frequently used in conjunction with both opiates and methamphetamines, and it was highly linked to binge drug use and polysubstance use.

Furthermore, findings from the 2018 National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration revealed that in the previous year, 5.4 million Americans abused prescription benzodiazepines such as midazolam.

What are the causes of Midazolam addiction?

The causes of midazolam addiction are multifaceted and involve a combination of factors that contribute to the development of dependency on this benzodiazepine. The causes of midazolam addiction are listed below. 

• Prescription dosage and duration: When individuals take midazolam in higher doses or for extended periods than initially prescribed, their bodies become accustomed to the drug’s effects. Prolonged use beyond recommended durations fosters a scenario where individuals find it challenging to function without the drug, ultimately paving the way for midazolam addiction to take hold.
• Genetic factors: Midazolam addiction is influenced by genetic factors, which impact differences in how the drug is metabolized and how receptors interact. In a 2022 study by Savarese et al., published in Addiction Biology, researchers wanted to know how ready high-drinking-in-the-dark (HDID) mouse lines were to consume other addictive medications like midazolam, methamphetamine, morphine, and nicotine. Its findings suggest that ethanol, midazolam, morphine, and nicotine addiction risk is shared genetically. This information could be helpful in designing new addiction treatment options.
• Psychological factors: The sedative and anxiolytic effects of midazolam provide a perceived escape or relief from psychological distress, leading to a risk of dependence. Co-occurring psychological issues, such as untreated anxiety disorders, potentially exacerbate the likelihood of developing midazolam addiction.
• Environmental factors: Addiction to midazolam is influenced by environmental factors that impact accessibility and social norms related to drug use. People who live in places where midazolam is easily obtainable, either through legal prescriptions or illegal means, are more likely to abuse the drug. Furthermore, in particular circumstances, cultural attitudes and peer influences alter views of midazolam use, contributing to patterns of overuse and addiction.
• Tolerance development: With continued usage, the body develops tolerance to midazolam, necessitating a higher dosage to achieve equivalent sedative and anxiolytic effects. An increase in dosage has the potential to induce a cycle of dependence, in which users feel obligated to consistently elevate their consumption. This further increases the likelihood of developing an addiction to midazolam, as they strive to regain the medication’s initial therapeutic benefits.  
• Self-medication: Self-administered prescriptions of midazolam for its sedative properties result in heightened potential for abuse and dependence. In the absence of professional supervision, users unintentionally increase their midazolam intake. This  leads to a cycle of dependence and an increased risk of developing an addiction to the drug as they attempt to cope with psychological distress on their own.
• Avoiding withdrawal: Individuals who become dependent on midazolam continue to use the medicine out of fear of experiencing unpleasant withdrawal symptoms. A continuous habit of intake reinforces the cycle of dependence and increases the likelihood of midazolam addiction as people try to avoid withdrawal.

What are the symptoms of Midazolam addiction?

The symptoms of midazolam addiction encompass a range of physical, behavioral, and psychological indicators indicative of a problematic and compulsive use of the benzodiazepine. The symptoms of midazolam addiction are listed below. 

• Intense cravings for the drug: With consistent usage, midazolam induces in individuals a profound inclination or obligation to pursue its effects, resulting in increased cravings. The persistent nature of these demands serves to strengthen the cycle of addiction and emphasize the psychological reliance that is distinctive of midazolam dependence. 
• Drowsiness: Excessive midazolam ingestion has sedative effects that last longer than the prescribed therapeutic period. Individuals who consume midazolam on a regular basis and in higher doses develop extreme drowsiness that affect their normal functioning.
• Memory loss: The sedative effects of the medication impair cognitive processes, such as memory formation and recall. In fact, a review article from Kameron Kaplan and Holly Christian Hunsberger published in the September 2023 issue of Frontiers in Pharmacology states that one significant negative effect of benzodiazepines (BZDs) is anterograde amnesia, which is the inability to create new memories. This was originally noticed in 1972 when diazepam doses administered intravenously caused a marked decline in recognition memory. Amnesia kicked in quickly, peaking two to three minutes after injection and lasting almost an hour.
• Aggression: Aggression as a symptom of addiction to midazolam arises due to paradoxical reactions, where the drug induces unexpected behavioral changes. While midazolam is generally prescribed for its calming effects, in some individuals, it leads to heightened irritability and aggression. This is because a decrease in 5HT neurotransmission induced by benzodiazepines may stimulate aggressive behavior, according to a 2018 article written by Carol Paton and published online by the Cambridge University Press.
• Headaches: Continuous midazolam usage has the potential to induce rebound headaches, wherein individuals resort to the drug to relieve pain as the effects of the medication fade off. Repetitive midazolam use to prevent these headaches is likely to foster a cycle of addiction and dependence.

When do Midazolam addiction symptoms usually occur?

Midazolam addiction symptoms usually occur after four weeks of treatment, since a continuing education activity by Lingamchetty et al., last updated in June 2023 on StatPearls found that around one-third of people taking the prescription develop a tolerance after such a period of time.

Symptoms of midazolam addiction typically manifest during periods of prolonged or excessive use of the drug. The risk of addiction symptoms becomes more apparent when the medication is used regularly, especially beyond the prescribed duration or in ways not recommended by healthcare professionals.

What are the signs of Midazolam addiction?

The signs of midazolam addiction include observable markers that indicate an individual is experiencing difficulties as a result of benzodiazepine overuse or reliance. The most common signs of midazolam addiction are listed below. 

• Non-prescription use of Versed: The non-prescription use of Versed (midazolam) indicates that an individual is obtaining and using the medication without a legitimate medical need or prescription. This behavior suggests a deviation from the intended and supervised use of the drug, as individuals are seeking its effects for non-medical purposes.
• Seeking multiple prescriptions from different physicians: This reflects deceptive behavior aimed at acquiring more of the drug than is medically necessary. This practice, known as “doctor shopping,” suggests a conscious effort to exploit multiple healthcare providers to obtain additional prescriptions, often to support escalating use or address tolerance.
• Requiring more of the drug to get the same effect: This sign of midazolam addiction describes the development of tolerance. Tolerance occurs when the body adapts to the presence of the drug, requiring an increased amount to produce the initial therapeutic response. This means that the risk of addiction is growing as people try to use more to counteract the effects that are wearing off.​
• Multiple failed efforts to cut back on or stop using Versed: Individuals who find it difficult to reduce or cease their use despite recognizing the negative consequences demonstrate a loss of control over their substance use. This pattern is a classic hallmark of addiction, emphasizing the psychological and behavioral aspects that contribute to the compulsive use of midazolam despite a desire to cut back or quit.
• Having signs of withdrawal when you stop taking the drug or lower your dose: Withdrawal symptoms arise as the body, having become dependent on the drug, reacts to the sudden decrease in its presence. Symptoms such as insomnia, irritability, fast heartbeat, and hallucinations are characteristic of the body’s struggle to adapt to the absence of midazolam.

What are the effects of Midazolam addiction?

The effects of midazolam addiction include a variety of physical, psychological, and social implications that result from the drug’s obsessive and long-term abuse. The effects of midazolam addiction are listed below. 

• Sleep problems: Individuals who use midazolam are likely to experience difficulties falling asleep naturally once the drug’s sedative effects wear off, potentially contributing to sleep-related issues as a consequence of its use. Furthermore, according to a 2022 fact sheet titled, “Benzodiazepines” from the Drug Enforcement Administration, benzodiazepines have been known to cause disturbing or overly realistic dreams.
• Constant tiredness: Prolonged use of midazolam, especially in excessive amounts, leads to a general sense of drowsiness and fatigue, contributing to feelings of tiredness. 
• Anxiety and depression: According to a 2020 review by Lim et al., published in the International Clinical Psychopharmacology, patients with depression who receive benzodiazepines may reflect a more ill or anxious group, though use of benzodiazepines is associated with poorer outcomes even within anxiety disorders. Long-term benzodiazepine use may have neuroadaptive consequences, which could explain these findings.
• Cognitive impairment: Memory, attention, and general cognitive function can all be negatively impacted by a midazolam addiction that lasts for a long time. Results from a 2022 study by Zetsen et al., published in the European Addiction Research revealed that 20.7% of the 92 long-term benzodiazepine users exhibited cognitive impairment across all domains; processing speed and sustained attention were the areas where the most pronounced effects were observed.
• Relationship strain: Addiction to midazolam strains interpersonal connections, creating disputes with family, friends, and coworkers. Erratic behavior, mood swings, and prioritizing of drug use above personal connections all lead to strained relationships.

What are the complications of Midazolam addiction?

The complications of midazolam addiction include ataxia, lasting memory deficits, respiratory depression, increased risk of accidents and injuries, rapid heart rate, low blood pressure, and even death. 

Addiction to midazolam induces ataxia, a condition characterized by impaired balance and coordination, which raises the likelihood of accidents and physical harm. Respiratory depression, an additional significant concern, arises due to the sedative properties of midazolam and has the potential to develop into life-threatening conditions. 

Chronic use leads to significant memory loss, changes in brain function, and a general loss of mental clarity. Additionally, midazolam causes complications such as hypotension (low blood pressure) and tachycardia (rapid heart rate), further stressing the cardiovascular system.

Finally, even at therapeutic levels, the combination of midazolam and other central nervous system (CNS) depressants, such as opioid medications and alcohol, cause fatal respiratory depression, according to a continuing education activity titled, “Midazolam” last updated in 2023 on Statpearls.

What are the available treatments for Midazolam addiction?

The available treatments for midazolam addiction use a holistic approach, treating the behavioral, psychological, and physical elements of this benzodiazepine dependence. The available treatments for midazolam addiction are listed below. 

• Detoxification: In a supervised detoxification program, healthcare professionals gradually reduce the dosage of midazolam, allowing the body to adapt to decreasing levels of the drug without experiencing severe withdrawal effects. This procedure lessens the possibility of seizures or rebound symptoms, which are dangers connected with abrupt withdrawal. Moreover, detoxification ensures a safer and more comfortable transition through the initial stages of recovery from midazolam addiction. 
• Cognitive behavioral therapy (CBT): In a study by Otto et al., published in the August 2010 issue of Behaviour Research and Therapy, a comparison was made between Panic Control Treatment for BZ Discontinuation (PCT-BD), taper-alone, and a taper plus relaxation condition in a sample of 47 patients who were attempting to taper off BZs. The fear of anxious sensations linked to stopping BZ is the focus of PCT-BD, an exposure-based cognitive behavioral therapy. At the six-month follow-up evaluation, the results showed that supplementary CBT had a statistically significant additive impact, outperforming both taper alone and taper plus relaxation. 
• Medication-assisted treatment (MAT): This treatment method involves the use of medications to support recovery and reduce the risk of relapse. According to Joe C. Hong on the 14th chapter of the book, “Treatments, Mechanisms, and Adverse Reactions of Anesthetics and Analgesics” published by the Academic Press, in the event of an overdose, flumazenil, a potent benzodiazepine antagonist, guarantees midazolam’s safety profile.
• Gradual tapering: An important part of treating midazolam addiction because it allows for a planned and organized way to lower the drug’s dose. This method involves gradually cutting back on midazolam over a set amount of time. This lets the body get used to lower levels of the drug while lowering the risk of serious withdrawal symptoms.
• Support groups: Support groups facilitate the healing process by offering a social setting where empathy, encouragement, and a shared experience will be found. Through connecting with others going through similar struggles, these groups—which are frequently led by qualified professionals—help people feel like they belong and understand one another. 
• Dual diagnosis treatment: Treatment for dual diagnosis joins proven methods for treating addiction with therapies for mental health problems, offering a complete and unified approach. People in dual diagnosis treatment are better able to recover from their substance use disorder and improve their general health because they are getting help for both conditions at the same time.
• Aftercare and relapse prevention: The main goal of aftercare and relapse prevention is to help people as they go from official treatment programs back to their normal lives. Aftercare usually includes ongoing therapy, counseling, support groups, or counseling sessions that offer ongoing support and direction. Strategies for preventing relapse are meant to give people the coping skills, stress management skills, and tools they need to figure out and deal with the triggers that are likely to make them use midazolam again.

When should you seek treatment for Midazolam addiction?

You should seek treatment for midazolam addiction as soon as hazardous patterns of use are identified. To stop the dangers of problems and dependence from increasing, early intervention is crucial. 

If you or someone you know is experiencing problems with midazolam use, you should get professional assistance if you notice symptoms like poor daily functioning, rising tolerance, unsuccessful attempts to reduce use, or withdrawal symptoms. 

The sooner treatment is started, the greater the likelihood of a full recovery and the avoidance of other adverse effects related to midazolam addiction.

Can Midazolam addiction be treated without medication?

Yes, midazolam addiction can be treated without medication. Treatment plans that don’t include medication can be effectively completed with behavioral therapies, counseling, and support groups. 

CBT, in particular, has demonstrated benefit in addressing the underlying ideas and behaviors linked with midazolam addiction. People share their stories, get advice, and build a strong support network through counseling and support groups. 

While medication-assisted treatment is effective for some, non-pharmacological therapies provide feasible and successful recovery pathways for many people. Individual needs, interests, and the severity of addiction often influence the treatment technique chosen.

What are the risk factors for Midazolam addiction?

Risk factors for midazolam addiction include a variety of characteristics that raise the possibility of an individual developing dependency on this benzodiazepine. The risk factors for midazolam addiction are listed below. 

• HIstory of substance use disorder: Individuals with a history of substance use disorder, whether involving benzodiazepines or other substances, are at an elevated risk of midazolam addiction. Prior experiences with addiction indicate a vulnerability to developing dependence on new substances, including midazolam.
• Long-term or high-dose prescriptions: Extended or high-dose prescriptions of midazolam, particularly when not closely monitored by healthcare professionals, increase the risk of dependence. Prolonged use leads to the development of tolerance, prompting individuals to escalate their dosage to achieve the desired effects and contributing to the potential for addiction.
• Lower socioeconomic status: Results from a 2020 study by Soyombo et al., published in the journal Family Practice showed that the practice-level Index of Multiple Deprivation (IMD) score (a marker of socioeconomic condition) was strongly correlated with the total prescribing of Z-drugs and benzodiazepines. This indicates that, even after controlling for age and sex, more prescriptions were written at offices that serviced a greater number of underprivileged patients.
• Network of individuals misusing benzodiazepines: One’s risk of addiction increases if they have a circle of friends or acquaintances that abuse benzodiazepines, including midazolam. Social ties that normalize or make the substance easier to obtain make it more likely that the person will misuse the drug among their peers.
• History of abuse: Findings from a 2018 study by Pierce et al., published in The Journal of Pain revealed that patients who reported solely child abuse, as well as those who experienced cumulative abuse, used more benzodiazepines than patients who reported no abuse or only adult abuse. Concurrent use of benzodiazepines was reported by one-third of persons with cumulative abuse episodes, compared to 14% of patients with no history of abuse.

How is Midazolam addiction prevented?

Midazolam addiction is prevented with the help of a multifaceted approach that addresses both individual and environmental factors. Healthcare providers play a crucial role by carefully evaluating the necessity of prescribing the drug, opting for short-term use when possible. 

Closely monitoring patients to minimize the risk of prolonged or excessive dosage is also a crucial step towards preventing the condition. Educational activities aimed at both the general public and healthcare professionals promote knowledge of the potential dangers of midazolam use as well as the need to follow prescribed recommendations.

Finally, encouraging complementary therapies for stress relief and anxiety management gives people non-pharmacological options. This reduces reliance on benzodiazepines like midazolam.