Midazolam Abuse, Risks & Addiction Treatment Options

Midazolam is the brand name for versed. Midazolam is a benzodiazepine that is rarely used outside of hospitals or clinical settings. It is very powerful and delivered intravenously, by injection, as a nasal spray, or buccally (between gum and cheek). It has a high risk of abuse and dependence.
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What is Midazolam?

Midazolam (the brand name for the drug "versed") is an FDA approved benzodiazepine, which is a class of drugs that produce sedative effects on the body and central nervous system (CNS). It works by increasing the effect of GABA (a natural chemical) in the brain.

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Midazolam is a powerful, short-acting hypnotic-sedative medication that triggers sleepiness and reduces anxiety. The drug has anticonvulsant, hypnotic, anxiolytic, amnestic, and muscle relaxant properties.

Though many benzodiazepines treat sleep disorders, midazolam is rarely used outside of hospital and clinical settings. It is used as a "premedication" before surgical procedures involving anesthesia. In some cases, midazolam is also used to treat seizures or combined with other drugs to treat schizophrenia or severe agitation.

Midazolam comes in five dosage forms, including:

  • Intravenous administration (IV midazolam)
  • Intramuscular (midazolam injection)
  • Intranasal (nasal spray)
  • Buccally (between the gum and cheek)
  • Sublingually (under the tongue)

A single dose of Midazolam lasts between one and six hours, which is why it’s not an ideal sleep aid.

The World Health Organization considers midazolam one of its "essential medicines," which means it is among the safest and most effective medications available when used properly. It is a benzodiazepine, and like other medications in this class, midazolam has a high risk of addiction and dependence.

The World Health Organization (WHO)
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Side Effects of Midazolam

Midazolam can trigger many adverse effects. Older adults should only take lower doses of midazolam because high doses can trigger more severe side effects.

Common side effects of midazolam include:

  • Nausea and vomiting
  • Dizziness
  • Drowsiness
  • Headache
  • Sleeping difficulty
  • Trouble breathing
  • Restlessness
  • Uncontrollable shaking
  • Aggression
  • Slow or irregular heart rate
  • Agitation

After administration of midazolam, continuous monitoring of respiratory and heart function is necessary until the patient is stable. This must be done in a clinical or hospital setting. Serious and life-threatening reactions have occurred in some patients, including airway obstruction, apnea, hyperventilation, and hypotension.

In obese pediatric patients, the doses of midazolam should be determined based on ideal body weight. When midazolam is combined with other sedatives or opioids, the risk for respiratory depression, airway obstruction, and hypoventilation increases.

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Midazolam Abuse Symptoms

As is the case with all benzodiazepines, midazolam has the potential for abuse and can be addicting. Abuse occurs when someone takes higher doses of a drug than prescribed. Abuse also includes taking a medication for longer than prescribed or combining it with other drugs, including alcohol.

Midazolam abuse symptoms might include:

  • Drowsiness
  • Lack of coordination
  • Slurred speech
  • Problems with concentration
  • Difficulty remembering things
  • Confusion
  • Dizziness

Midazolam and other benzodiazepines are relatively safe medications when used under a doctor’s supervision, but they can be dangerous when abused. Abuse doesn’t always mean a person is addicted, but it increases the likelihood of addiction occurring.

In addition, when midazolam is used long-term in an intensive care unit (ICU) or clinical setting, the risk for addiction increases.

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Midazolam Addiction Symptoms

Ongoing abuse alters the brain’s chemistry by changing its neural pathways. This can lead to addiction and potential dependence. Physical dependence can happen within just a few weeks of using the drug. Some estimates show that benzodiazepine dependence occurs in a third of those using these drugs for more than a month.

Addiction is a DSM-5 diagnosed disease characterized by behavioral issues. Dependence refers to a physical reliance on a substance. Addiction and dependence often occur at the same time, but a person can be dependent on a substance without being addicted to it.

Symptoms of a midazolam addiction are similar to those of other drugs, especially benzodiazepines, and include:

  • Intense cravings
  • Poor judgment and decision-making
  • Practicing drug-seeking behaviors
  • Compulsive use of the drug
  • Inability to stop using the drug
  • Developing tolerance and dependence
  • Continuing to use the drug even with negative consequences
  • Prioritizing using the drug over everything else
  • Lying or stealing to cover up using or to get more of the drug
  • Financial and legal problems

It is also more likely that a person with a midazolam addiction will become addicted to other substances. Or, they may already be abusing other substances before midazolam use begins. Multiple-substance abuse can create challenges for recovery; and it is also common for someone addicted to midazolam to have a mental health disorder.

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Midazolam Withdrawal Symptoms

Stopping ongoing use of midazolam can trigger withdrawal symptoms. This is common when a person is abusing benzodiazepines or stops “cold turkey” and makes recovery more difficult.

Someone with an addiction tends to have a better chance of recovery if they gradually taper their dosage of the medication with a doctor’s supervision. Medical detox is helpful for treating withdrawal symptoms and helps reduce the intensity of symptoms.

Withdrawal symptoms associated with midazolam dependence are similar to other benzodiazepines and include:

  • Problems sleeping
  • Runny nose
  • Anxiety
  • Irritability
  • Panic attacks
  • Tremors
  • Shaking
  • Sweating
  • Problems with concentration
  • Confusion and memory problems
  • Cognitive impairment
  • Nausea and vomiting
  • Headache
  • Muscle pain

Severe cases of midazolam withdrawal can trigger seizures, hallucinations, psychosis, and suicidal thoughts/behaviors.

Graphic of head filled with swirl

Midazolam Overdose

A midazolam overdose is extremely dangerous and can be fatal. Call emergency services or the Poison Help line at 1-800-222-1222 if you suspect an overdose is occurring. If the drug administration was in a clinical setting or an intensive care unit, an overdose is rare.

Symptoms of midazolam overdose can include:

  • Impaired motor coordination and reflexes
  • Slurred speech
  • Involuntary eye movements
  • Difficulty staying awake
  • Dizziness and/or drowsiness
  • Extreme confusion
  • Hypotension
  • Respiratory arrest
  • Blurred vision
  • Hallucinations
  • Coma and death
Two pills mixing equals dangerous

Drug Interactions

A total of 451 drugs can interact with midazolam, and 32 can produce serious interactions. Serious drug interactions increase a user’s risk for severe side effects such as drowsiness, confusion, memory loss, and/or respiratory depression.

The most common drugs known to interact with midazolam include:

  • Antidepressants (such as sertraline, nefazodone, and fluoxetine)
  • Antiepileptic drugs (such as phenytoin, phenobarbital, and carbamazepine)
  • Heart or blood pressure medications (such as diltiazem)
  • Seizure medications (such as phenytoin)
  • Certain antibiotics (such as clarithromycin and erythromycin)
  • Tuberculosis medications (such as rifapentine and rifampin)
  • Antifungal medications (such as ketoconazole and itraconazole)
  • Protease inhibitors, antiviral medications taken for HIV/AIDS or hepatitis C
  • Grapefruit juice
  • Antihistamines
  • St. John's Wort
  • CNS depressants

Toxicity with midazolam can also occur when combined with central nervous system (CNS) depressants like opioids (e.g., fentanyl, codeine, and morphine), alcohol, and other tricyclic antidepressants.

Before taking midazolam, also discuss any allergies you have and tell your doctor if you are taking any other benzodiazepines, such as diazepam.

Graphic of hospital.

Treatment for Midazolam Addiction

Treatment is available for people with an addiction to or who have been abusing midazolam. Benzodiazepine addiction is a common reason people enter treatment programs. In some cases, these people require treatment for multiple substance addictions. Some might also have co-occurring mental health disorders.

The most effective treatment programs for midazolam addiction and dependence address medical, social, and psychological issues.

Inpatient treatment, outpatient treatment, or a combination of the two are common treatment options for midazolam addiction. For example, someone who abuses midazolam short-term might only require outpatient treatment. However, ongoing abuse that has led to addiction or physical dependence will likely require inpatient treatment followed by ongoing outpatient support.

The goal of addiction treatment is to help the affected person detox from the drug and, if necessary, learn about his or her addiction, deal with cravings, and prevent relapse.

Midazolam FAQs

What is the drug midazolam used for?

The intended use of midazolam is for preoperative sedation. The drug relieves anxiety and produces feelings of sleepiness and drowsiness before surgical procedures. When midazolam is administered, a patient will experience a loss of consciousness during the procedure.

In some cases, midazolam is also used to treat seizures or combined with other drugs to treat schizophrenia or severe agitation.

Is midazolam stronger than diazepam?

Midazolam and diazepam are both benzodiazepine medications. However, midazolam is 3 to 4 times as potent per mg as diazepam. It is also faster acting and causes deeper levels of amnesia that diazepam.

How long does midazolam last?

Midazolam is a short-acting benzodiazepine; a single dose lasts between one and six hours.

Is midazolam given to patient at end of life?

Midazolam is one of the most common drugs administered to cancer patients near end of life, along with morphine and haloperidol. Terminally ill cancer patients often experience refractory symptoms. Sedative medications are used to alleviate these symptoms (palliative sedation therapy).

How long does midazolam take to work?

A midazolam injection takes up to 15 minutes to work. An intravenous (IV) dose of the drug begins working in five minutes or less.

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Resources

“Midazolam: MedlinePlus Drug Information.” Medlineplus.Gov, https://medlineplus.gov/druginfo/meds/a609003.html

“List of World Health Organization Essential Medicines.” Academic Dictionaries and Encyclopedias, https://enacademic.com/dic.nsf/enwiki/6592318

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Updated on: September 22, 2020
Author
Addiction Group Staff
About
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Medically Reviewed
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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