June 4, 2023

Clonazepam presentation by Jesse Vanous for Substance Misuse & Addiction course.

All right hey everybody my name is jesse and my substance of abuse presentation is going to cover clonazepam so clonazepam is in a sedative hypnotic class of compounds known as benzodiazepines and it’s commonly referred to by its brand name klonopin street names include things like colonies clones k-pins clauses and klondike bars which is an homage to its more

Popular benzodiazepine cousin the zany bar which is another name for a xanax based on the uppers downers and all-arounders classification clonazepam would be considered a downer because it is a major depressant the first benzodiazepines were developed by chemist leo sternbach on behalf of the hoffman la roche company discovered by accident in 1955 benzodiazepines

Were patented as a safer alternative to barbiturates which at the time included things like the now defunct quaalude throughout the 1960s these medications were widely prescribed for seizure disorders including epilepsy insomnia anxiety panic and the now antiquated female hysteria and i have included a sexist ad from the roche company from 1965 promoting the

Sex-specific effectiveness of valium which is one of the earliest long-acting benzodiazepines to ever hit the market so many of these early benzodiazepines were heavily advertised to so-called housewives of the 1960s and 1970s in 1965 the hoffman la roche company patented clonazepam as its newest addition to the benzodiazepine family and by 1975 clonazepam was being

Marketed by the roche family as uniquely suited among its benzodiazepines to treat epileptic seizures and that’s in addition to all of its marketed anti-anxiety properties by this point most of roche’s benzodiazepines have become scheduled for substances and clonazepam would soon meet a similar fate when the dea added it to the schedule 4 list upon its release to

The market in 1975. so clonazepam remains a schedule for compound to this day meaning it has legitimate medical uses low potential for abuse and low potential for dependence relative to schedule three compounds and we’ll talk about why i put low in quotation marks there um so like other benzodiazepines clonazepam is only available via prescription and in virginia

Illicit possession of clonazepam as a class 2 misdemeanor punishable by up to six months in prison and or a fine of a thousand dollars so moving on to uses despite its black market availability clonazepam is most commonly acquired from primary care physicians fda approved clonazepam tablets are available in dosages ranging from 0.125 to 2 milligrams unfortunately

The literature suggests that the dea’s low potential indicators are total misnomers because although clonazepam is commonly prescribed for all of these things including um panic disorder epilepsy non-convulsive epileptic seizures off label for restless leg syndrome acumenia and insomnia clonazepam is also widely misused outside of the illicit medical context

And it’s often misused in conjunction with substances including alcohol and opioids although it’s most commonly ingested orally in its prescribed standard or dissolvable tablet form it can also be injected intravenously when mixed with a liquid solution or consumed via intranasal insufflation which is commonly done by crushing the tablets into a fine powder and

Then snorting them it can also be smoked but this method is quite rare like most gaba agonists clonazepam psychoactive effects are often described as similar to alcohol and these include things like emotional blunting or numbing short-acting antidepressant and anxiolytic effects including things like muscle relaxation mild euphoria and lowering of behavior visual

Inhibition so again very similar to alcohol there’s a lot of overlap between the psychoactive effects and the short-term health implications which include drowsiness dizziness incoordination blurred vision increased potential for risk behaviors like driving while impaired poly substance use and unprotected sex increased risk of sexual victimization resulting from

Anterograde amnesia respiratory depression overdose and of course death because it’s important to remember that clonazepam like all benzodiazepines is a central nervous system depressants so the risk of overdose and death increases at higher doses and when taken concurrently with other donors um benzodiazepines and opioids have an especially lethal cumulative

Effect long-term effects include things like episodic memory loss chronic muscle weakness increased aggression poor concentration emotional blunting insomnia social isolation increased overdose risk and there’s some evidence that birth defects are possible and neonates born from pregnant long-term users so perhaps the most dangerous long-term health implication

Of prolonged clonazepam use is withdrawal because the tolerance to clonazepam tends to develop rather quickly cessation must be carefully monitored and slowly tapered and as you can see i’ve included the proximate dosing required for the development of physical dependency here on the slide withdrawal symptoms resulting from abrupt discontinuation include things

Like headache nausea vomiting insomnia irregular heartbeat muscle pain hypertension inability to focus seizures non-epileptic convulsions and death symptoms typically weighing 7 to 20 days post cessation but protractive withdrawal symptoms can last for several months in long-term users this is known as post-acute withdrawal symptoms syndrome or pause so moving

On to history of treatment options benzodiazepine physical dependence was suspected by the time the roche company marketed clonazepam in 1975 but it really wasn’t until the early 1980s that evidence was sufficient enough to establish its frequency and severity especially among especially the severity of physical dependence and long-term users between 1975 and

1987 treatment options were limited to psychosocial group modalities including those employed by the betty ford clinic and narcotics anonymous since the american medical association adopted the medical model of addiction in 1987 alternative treatment options have become available over time so this is one of the rare instances where the medical model generally

Improved things especially for physically dependent users pharmacological treatment is now often a necessary first step and this treatment seeks to manage withdrawal symptoms and it accomplishes this by exchanging the patient’s intermediate acting clonazepam with a longer acting benzodiazepines such as diazepam the patient’s daily maintenance diazepam dose is then

Slowly tapered down over a time frame that’s determined by the patient’s dosage frequency and length of use so the goal here is to stabilize the patient and then slowly decrease the diazepam administrated dosage over time um psychotherapeutic interventions seek to accomplish three primary goals we want to facilitate the withdrawal we want to facilitate long-term

Abstinence and we want to treat the underlying disorder for which clonazepam is used so this corresponds with the idea that benzodiazepines are commonly misused as a means of self-medication efficacious psychotherapeutic modalities include things like motivational interviewing individual and group cognitive behavioral therapy psychodynamic therapy family systems

Interventions and addiction support group non-pharmacologic modalities like those listed above are typically most effective when psycho-education is incorporated this includes things like sleep hygiene education relaxation techniques mindfulness meditation etc so why does it matter for social workers well direct practice social workers including individual and

Group clinicians case managers medical social workers and school social workers are often the initial point of contact for individuals who are dependent on benzodiazepines so whether the provider actually facilitates the relevant therapy refers out to a specialist or provides initial psychology psycho-education understanding the unique etiology of benzodiazepine

Addiction and the potential for co-occurring mental health conditions is highly determinative of client outcomes so competency corresponds with provider effectiveness so for example if a client discloses that they use clonazepam we have to be very careful about how we go about helping the clients discontinue use if that is the ultimate goal of the client so you you

Want to make sure that the tapering process for example is monitored by a qualified medical provider before jumping into something like motivational interviewing or cbt alone so from a macro or systems oriented perspective understanding the role of over over prescribing and inadequate prescription monitoring can profoundly inform how social workers advocate for

Certain vulnerable populations especially with those with limited access to psychiatric services also adults ages 50 to 65 are especially vulnerable as this is the stage this is the age group with the highest clonazepam usage rates surprisingly social workers may also advocate for policy prescriptions that seek to ameliorate the over-prescribing crisis promote

Non-pharmacologic or non-benzodiazepine alternatives and expand addiction treatment access particularly in rural areas where access is limited and of course social workers play an integral role in reducing stigma by promoting destigmatizing initiatives and speaking openly about addiction in the communities in which we work um we can help increase help seeking

Behaviors and we can reduce self-stigmas among our most vulnerable populations all right thank you all for listening and my references are attached

Transcribed from video
Jesse Vanous Clonazepam Presentation By Jesse