Midazolam Addiction, Risks, and Treatment

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.
Evidence Based
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What is Midazolam?

Midazolam is the brand name for the generic drug versed. It’s a member of the class of drugs known as benzodiazepines. Though many benzodiazepines treat sleep disorders, this drug is rarely used outside of hospital or clinical settings. In some cases, it is used for treating seizures or combined with other drugs to treat schizophrenia or severe agitation. It is also used before surgical procedures involving anesthesia.

Midazolam is a powerful medication that triggers sleepiness and reduces anxiety. It can be given intravenously or by injection and is also available as a nasal spray. Lastly, it can be administered buccally (between the gum and cheek) or sublingually (under the tongue). It works quickly for most people and lasts for just one to six hours, which is why it’s not considered ideal as a 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 its class, it has a high risk of addiction and dependence.

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Side Effects of Midazolam

Midazolam can trigger many different side effects. Most are mild to moderate and include:

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

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

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.

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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.

Further, Addiction is a DSM-5 diagnosed disease characterized by behavioral issues. Dependence refers to a physical reliance on a substance. They 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 all else
  • Lying or stealing to cover up using or to get more of the drug
  • Financial and legal problems

It’s also more likely a person with a Midazolam addiction will become addicted to other substances or already be abusing other substances when he or she begins using the drug. Multiple-substance abuse increases the potential to use the drug and creates challenges for recovery. It’s also common for someone addicted to Midazolam to also have a mental illness.

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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. People with an addiction tend to have a better chance at 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 to reduce the intensity of symptoms.

Specific 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 withdrawal can trigger:

  • Seizures
  • Hallucinations
  • Psychosis
  • Suicidal thoughts and behaviors
Two pills mixing equals dangerous

Drug Interactions

A total of 451 drugs can interact with Midazolam, and 32 can produce serious interactions. The most common drugs known to interact with Midazolam include antidepressants, antipsychotics, heart medications, and seizure medications. Serious interactions include increasing a user’s risk for and severity of side effects such as drowsiness, confusion, memory loss, or trouble breathing.

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Treatment

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 and in some cases, these people need treatment for multiple addictions. Some might also have co-occurring mental health conditions.

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

Treatment can occur on an inpatient or outpatient basis or combine the two. Someone who abuses Midazolam for just a short time might need only outpatient treatment. Ongoing abuse that has led to addiction or physical dependence will likely require inpatient treatment followed by ongoing outpatient support. The goal of treatment is to help the affected person detox from the drug if necessary, learn about his or her addiction, deal with cravings, and prevent relapse.


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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: June 24, 2020
Author
Addiction Group Staff
About
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Medically Reviewed: March 11, 2020
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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