As part of the Controlled Substances Act (CSA) of 1970, illicit and prescription drugs fall into various Schedules based on safety, abuse potential, accepted medical use and other key criteria. The most-restricted classification, Schedule I, reflects dangerous substances with high abuse potential and no medical value. On the other end of the spectrum, Schedules IV and V are the least-restricted categories, and individuals can typically procure such prescriptions with ease. Unfortunately, political posturing appears to play some role in classification when schedule makers show such egregious bias against cannabis and leniency toward benzodiazepines.
Cannabis has a Schedule I classification joining hardcore drugs like LSD, PCP, mescaline, heroin, peyote, psilocybin mushrooms, Peruvian torch cactus and Etorphine, an opioid 3,000 times more potent than morphine. The placement epitomizes the government’s stance that cannabis requires more restrictions and regulation than Schedule II drugs like cocaine, opium and crystal meth. The scheduling, which makes the plant illegal without exception, also puts onerous restrictions on clinical studies and medical research, and the government targeted cannabis with additional layers of oversight. From 1999 to 2015, the U.S. Public Health Service (PHS) had to approve cannabis-related research, a review process only applied to cannabis and that rarely allows research into therapeutic uses. President Obama lifted this restriction in June 2015, to which the Marijuana Majority responded, “The next step should be moving marijuana out of Schedule I to a more appropriate category, which the administration can do without any further Congressional action.”
Benzodiazepine, meanwhile, is Schedule IV, which suggests the drug must entail significantly less danger and abuse. But does it?
Benzodiazepines are a class of central nervous system (CNS) depressants that includes brand names like Xanax (alprazolam), Valium (diazepam), Klonopin (clonazepam) and Ativan (lorazepam) and street names like Benzos, K-Pin and Xannies. The drug is a chemical fusion of benzene and diazepine rings that bind to gamma-aminobutyric acid (GABA) receptor sites in the CNS. The binding opens a chlorine (Cl-) channel and increases the concentration of Cl- ions in the postsynaptic neuron, which hyperpolarizes the neuron and makes it less excitable. Benzodiazepines are, in effect, a way to enhance the efficacy of GABA neurotransmitters, which can potentially reduce anxiety, panic attacks, muscle spasms, epilepsy, seizures and insomnia. In most cases, benzodiazepines are meant to act as a short-term bandage, not a cure or maintenance plan, since extended use prompts the brain to compensate for the enhanced efficacy by reducing natural GABA production. This process, known as downregulation, can occur in as little as four weeks.
“The diagnosis and management of benzodiazepine dependence,” a study published in Current Opinion in Psychiatry in 2005, wrote, “Despite repeated recommendations to limit benzodiazepines to short-term use (2–4 weeks), doctors worldwide are still prescribing them for months or years. This over-prescribing has resulted in large populations of long-term users who have become dependent on benzodiazepines and has also led to leakage of benzodiazepines into the illicit drug market.”
Once a person becomes physically dependent on benzodiazepine, quitting the drug abruptly can result in multi-year withdrawal symptoms and potentially fatal grand mal seizures. The “sharp sting in the tail” is how the Journal of the Royal College of General Practitioners characterized the withdrawals in 1989, while “Withdrawal from Long-Term Benzodiazepine Use” in The British Journal of General Practice in 2006 emphasized the necessity for medically supervised detoxification and gradual reductions in dosage.
Recovery from benzodiazepine dependence and addiction also involves high rates of relapse. In 2011, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a special Treatment Episode Data Set (TEDS) report on the drug. The findings noted that benzodiazepines lead all drugs in rehabilitation admissions involving previous rehab stints (70.5 percent), and 38.6 percent reported three or more previous admissions. The study added that 95 percent of benzodiazepine-addiction admissions—which increased threefold between 1998 and 2008—also involved other substance addictions. And taking benzodiazepines with other drugs is yet another area of concern.
Once a person becomes physically dependent on benzodiazepine, quitting the drug abruptly can result in multi-year withdrawal symptoms and potentially fatal grand mal seizures.
“Acute respiratory failure from abused substances,” a study published in the Journal of Intensive Care Medicine in 2004, said alcohol, cocaine, amphetamines, opiates and benzodiazepines increase the risk of a CNS depression (i.e., overdose) when two or more are taken in tandem. These substances interact with the medulla—a part of the brain stem that helps regulate the respiratory and cardiovascular systems—symbiotically enhancing each other’s effects. Cannabis-related neural receptors are not prominent in the medulla so the plant does not physiologically contribute to such overdoses. The study also noted that CNS stimulants (e.g., amphetamines, Ritalin, Adderall) can exhaust the respiratory system, which lowers the threshold for respiratory failure when combined with benzodiazepine-class depressants. This finding is particularly concerning since many stimulant users turn to depressants to take the edge off later.
The Citizens Commission on Human Rights International in 2011 characterized Klonopin (a benzodiazepine with a long half-life) as “America’s Most Dangerous Pill,” while the Addiction journal that same year published “Benzodiazepines Revisited—Will We Ever Learn?” documenting 50 years of problems. When addictions do take hold, the American Family Physician in 2000 said symptoms can include memory impairment, psychomotor retardation, emotional blunting and paradoxical disinhibition inciting aggression, impulsivity and rage. Furthermore, the U.S. Food and Drug Administration (FDA) warning guide for the medication suggests that one in 500 users experiences suicidal thoughts. So, if everyone at a 50,000-seat Rolling Stones concert regularly takes “Mother’s Little Helper,” approximately 100 of them feel suicidal impulses because of it.
Whether taken medically or recreationally, benzodiazepines are associated with high rates of misuse and abuse. PBS News reported in 2013 that depressants are the second-most abused class of prescription drugs (trailing painkillers), yet their Schedule IV status makes for relatively easy access through prescriptions or illicit sales. The U.S. Centers for Disease Control and Prevention (CDC) highlighted the drug’s availability in a recent report that said U.S. prescribers wrote 37.6 benzodiazepine prescriptions for every 100 people in 2012. For the sake of clarity, that is 37.6 sets of pills, not individual pills.
If everyone at a 50,000-seat Rolling Stones concert regularly takes “Mother’s Little Helper,” approximately 100 of them feel suicidal impulses.
In 2013, the U.S. Court of Appeals for the D.C. Circuit ruled on Americans for Safe Access v. Drug Enforcement Administration, a federal case involving cannabis as a controlled substance. The patient-advocacy group Americans for Safe Access sought a reclassification of cannabis to at least Schedule III—at the time the same classification as opium poppy-produced Vicodin—and still more restricted than benzodiazepines. The National Institutes of Health (NIH) has a patent on cannabinoids as neuroprotectants, and the National Institute on Drug Abuse (NIDA) recently cited studies suggesting “whole-plant marijuana can slow the growth of cancer cells” and possibly kill certain cancer cells. Nevertheless, the DEA argued that cannabis has no “accepted medical use,” and the three-judge panel sided with the DEA.
When looking at the clinical findings, many might agree that benzodiazepine involves significantly more risk than cannabis, yet the scheduling denies any access to cannabis and relatively easy access to benzodiazepine. What motivates the disparity? Several factors might play a role, but the pharmaceutical industry as a whole is the national leader in lobbyist spending. The Center for Responsive Politics reported that it spent $231 million on lobbying in 2014, which dwarfs the $141 million spent by the oil and gas industry. The reclassification fight continues, but government intent is certainly suspect as long as cannabis remains Schedule I and benzodiazepines Schedule IV.
Image by Ben Frost.