Benzodiazepines

Main type

Benzodiazepines are drugs that are categorised as depressants. They are legally produced and prescribed to treat anxiety, insomnia and depression. Used recreationally, they might be used to combat the ‘come down’ effects of stimulants like cocaine and amphetamine. There are many different kinds of benzodiazepines marketed under a variety of brand names. One of the most common benzodiazepines is Diazepam, which is marketed under the name Valium. Prolonged use of benzodiazepines carries a high risk of addiction.

These types of drugs were discovered by the Austrian chemist Dr Leo Sternbach in 1954. Dr Sternbach was working for Hoffman-La Roche, a pharmaceutical company whose laboratories had submitted the drug for scientific evaluation. Benzodiazepines were quickly identified as being more effective than barbiturate drugs, with less addictive qualities and a lower risk of overdose. The first benzodiazepine drug (chlordiazepoxide) was patented in 1959. It was introduced worldwide in 1960 under the name Librium and prescribed to relieve anxiety. Related compounds of this drug were tested in the subsequent years, which led to the introduction of diazepam, commercially named Valium, in 1963. Continued experimentation into benzodiazepines resulted in the creation of further derivatives such as nitrazepam, known as Mogadon, in the 1960s and alprazolum, known as Xanax in the 1980s. It was in the 1980s that benzodiazepines became the most commonly prescribed depressant drugs in the world. It was also during this time that benzodiazepine addiction and abuse became recognised as a widespread problem.

Benzodiazepines act by slowing down the activity of the central nervous system and brain. Used in high doses they can make someone feel euphoric and intoxicated, especially when combined with other depressants such as alcohol.

Benzodiazepines come in the form of a tablet or capsule which are most commonly white or blue in colour. The pills vary in size, usually depending on the size of the dose per capsule. They are often stamped with the logo of the pharmaceutical company that they have been manufactured by. They are most commonly swallowed but some illicit users ground the pills into a powder and mix with liquid so that they can be injected.

Other Types

Benzodiazepines are generally referred to by either their chemical name or the name by which they are commercially marketed. Diazepam is most famously known as Valium but also marketed under the name Dulcene. The benzodiazepine oxazepam goes by the names Alepam, Serepax and Murelax. Nitrazepam is sold under the names Alodorm and Mogadon. Temazepam is marketed as Euhypnos and Normison. Flunitrazepam is marketed as Rohypnol and has gained notoriety for being used in sexual assault, being dubbed in the media as ‘the date rape drug’.

Street names for benzodiazepine drugs include ‘benzos’, ‘tranx’, ‘sleepers’, ‘serras’ (for Serepax), ‘moggies’ (for Mogadon) and ‘normies’ (for Normison). Diazepam tablets might be known as ‘vallies’, ‘diazzies’ and ‘wobblies’, or ‘blues’, ‘whites’ or ‘yellows’, in reference to the colour of the pills.

Benzodiazepine might also be referred to as ‘downers’ or go by the vague terms of ‘pills’ or ‘tabs’.

Major Effects

The effects of benzodiazepines usually start to be felt within one hour of taking them. Depending on the size of the dose, their effects can last for a few hours or up to a few days. Most commonly, benzodiazepines cause someone to feel very relaxed and sleepy and relieve feelings of anxiety. Taking the drug might also cause someone to feel dizzy, isolated or confused. Slurred speech, dry mouth, blurred or double vision and short term memory loss are all common effects from high doses of benzodiazepines. Other effects can include mood swings, euphoria, inability to judge distances or movement, constipation, diarrhoea, nausea and vomiting. Taking large doses of benzodiazepines can cause a person to fall into a coma or die.

Benzodiazepines can be highly addictive if taken over a prolonged period, i.e. over two or three weeks of constant use. Long-term users of benzodiazepines may experience a constant lack of energy, be irritable, feel nauseous, have frequent headaches, an increased appetite and experience bad dreams. Long-term benzodiazepine use can bring on feelings of depression and suicidal thoughts. It can cause users to break out in skin rashes, lose interest in sex and, for women, it can interfere with the menstrual cycle.

Taking benzodiazepines with other depressant drugs like alcohol or opiates like heroin can amplify the effect of the drug and increase the chances of overdose.

When benzodiazepines are combined with stimulant drugs like ecstasy or amphetamine, the body is placed under a high degree of stress as it attempts to deal with the conflicting effects of the drugs.

Production countries

Benzodiazepines are legally manufactured under license in the majority of industrialised nations throughout the world. In the USA and all European Union countries the drug is only available on prescription from a doctor. In some countries, including India, Thailand and Turkey, the drug is available to buy ‘over the counter’.

Of all the drugs prescribed to alter mood, benzodiazepines are the most prescribed worldwide.

In terms of illicit production of benzodiazepines, one source are those obtained on prescription that have been diverted for recreational use. This is usually done by buying the drug from someone who has been prescribed it for legitimate use. There are also cases of thefts of the drug from pharmacies and pharmaceutical storage warehouses.

Dealers of benzodiazepines for illicit use are believed to travel abroad to countries where the drugs may be purchased without prescription, but increasingly ordering from the Internet has become more common in recent years.

The benzodiazepine phenazepam was initially developed in the former Soviet Union and is now legally produced in Russia and some other countries in the so-called Commonwealth of Independent States including Ukraine and Kazakhstan. Phenazapam is most often used to treat epilepsy and is also used in the field of anaesthesia, particularly for dental work. In the USA and most of Europe the drug is not under government control and can therefore be purchased legally on the Internet. As such the drug has begun to be used recreationally as a substitute for other drugs such as diazepam (Valium). Nine cases of overdose of phenazepam were recorded in the UK in 2010.

Facts and stats

FACTS

  • Benzodiazepines are drugs that are prescribed for anxiety, insomnia and depression. They include a wide variety of different drugs that are marketed under various brand names. They are highly addictive when taken for an extended period of time and have unpleasant withdrawal effects once someone stops taking them. Here are some more essential facts about benzodiazepines.
  • The drug was discovered in 1954 and manufactured by the Hoffman-La Roche pharmaceutical company.
  • Diazepam, known as Valium is one of the most widely prescribed benzodiazepines.
  • People who regularly take benzodiazepines can develop a tolerance to them, meaning they have to take increased doses to achieve the same effect.
  • Benzodiazepines are both physically and psychologically addictive.
  • Addiction can occur within four weeks of regular use.
  • The drug acts on the brain and central nervous system.
  • Mixing benzodiazepines with other drugs increases their effect and can lead to overdose and death.
  • Benzodiazepines come in the form of pills or tablets in various dose sizes.
  • Rohypnol is a benzodiazepine that has become known as ‘the date rape drug’ due to its use in a number of sexual assault cases.
  • Small doses of benzodiazepines can cause a feeling of general well-being, relaxation and drowsiness.
  • Large doses can cause effects similar to alcoholic intoxication with loss of coordination and slurred speech.
  • Withdrawal symptoms from benzodiazepines include anxiety, confusion, convulsions and aching muscles.
  • In most countries benzodiazepines are only available via prescription from a doctor, but in some like India and Thailand, they may be bought ‘over the counter’.

STATS

  • In 1975 a total of 103 million prescriptions for benzodiazepines were issued in the USA.
  • Between 1990 and 1996 benzodiazepines were identified as being responsible for 1,810 deaths in the UK. This was more than the deaths from all other Class A drugs combined, including deaths from heroin and cocaine.
  • Between the years 2002 and 2007 prescriptions for the drug rose from 69 million to 83 million in the USA.
  • A 2007 survey of teenagers found that in thirty-five European countries there was an average of 8% of 15-16 year-olds who were being prescribed benzodiazepine tranquillisers, and 4% of the same age group had used these drugs without prescription. It was found that Poland had the largest percentage of this age group using benzodiazepine tranquillisers without prescription, with 18% of 15-16 year olds admitting use. This was followed by Lithuania, where 16% of 15-16 year olds had used non-prescription benzodiazepines, France with 15% and Italy with 10%.
  • In the UK there were over 10 million prescriptions for benzodiazepines were written out in 2008.
  • The International Narcotics Control Board found that in 2009, Europe was the highest consumer of benzodiazepines.
  • There are around 1.5 million benzodiazepine addicts in the UK despite, prescriptions for the drug falling from a peak of 31 million in 1979.
  • Out of all those dependent of the drug in the UK it is estimated that half a million are medium-term users and around 3 million are short-term users.
  • It is estimated that there are over 2000 different types of benzodiazepines that have been synthesised to date and around 40 benzodiazepine derivatives are commercially available.

Addiction Signs

Someone who has consumed large quantities of benzodiazepines may display behaviour similar to those associated to alcohol intoxication, i.e. slurred speech and loss of co-ordination. They may also seem extremely drowsy and lethargic.

It can be difficult to detect addiction to benzodiazepines because someone may be legitimately taking the drug as prescribed by a doctor and become tolerant to the drug over time. This means they may need to increase their dose in order to achieve the same therapeutic effect. In as little as four weeks of regular use they may become dependent on the drug, with serious consequences when they try to stop taking it.

Someone in a state of withdrawal from benzodiazepines may show signs of insomnia, with dark circles around their eyes and a pale complexion. They may seem nervous or tense, depressed, confused, distant or paranoid. They may complain of muscle stiffness, shake or convulse uncontrollably or display flu-like symptoms. Blurred vision, hyper-sensitivity to light, extreme lethargy, indigestion, abdominal cramps, nausea and memory loss are further signs of benzodiazepine withdrawal.

Someone addicted to benzodiazepines may increase their dosage, which may lead to overdose. Someone who has overdosed on benzodiazepines may lose consciousness, have a slowed heart beat, slow, shallow breathing, cold, clammy skin and their lips may be bluish in colour, revealing signs of oxygen starvation.

Although benzodiazepines are almost exclusively swallowed in the form of pills or tablets, some addicts will grind these into a powder and mix with liquid to be injected, in which case needle puncture marks may be observed on the arms, legs, ankles or backs of the knee.

Treatments

In cases of benzodiazepine overdose, treatment in hospital is essential. If the drugs were consumed within the previous two hours, a doctor may perform ‘gastric lavage’ where large quantities of water are pumped into the stomach via a tube in an attempt to wash out the benzodiazepines not yet absorbed into the bloodstream. Liquid charcoal is sometimes administered, which has the effect of preventing further absorption of the drug. To counter the sedative effects of benzodiazepines, drugs such as flumazenil, also known as Romazicon can be given, although these drugs can cause serious side effects in chronic abusers of benzodiazepines.

The most common way to treat someone with addiction to benzodiazepines is to taper off their dose of the drug gradually so that the more life-threatening side effects of withdrawal can be minimised. Suddenly stopping taking benzodiazepines after the body has become dependent on the drug can have serious and potentially fatal consequences.

Many with a dependence on benzodiazepines will have been taking the drug to treat anxiety or insomnia, in which case alternate therapies for these conditions should be put in place. Additional medication may be given, such as anti-depressants to assist in the withdrawal process. Drugs known as beta-blockers may be prescribed to deal with the physical withdrawal symptoms like convulsion and seizure. Residential rehabilitation may be appropriate for benzodiazepine addicts to support them in the challenging task of overcoming addiction. In most cases, however, rehabilitation and the gradual reduction in benzodiazepine intake may be completed as an outpatient.

In addition to gradual withdrawal from the drug, in most cases psychological support will be given in order to support the addict in their rehabilitation and address the possible underlying reasons for dependence on benzodiazepines. Finding non-pharmaceutical methods for coping with stress and anxiety may also be appropriate for a benzodiazepine addict in a rehabilitation programme. Strategies for dealing with insomnia may include use of relaxation tapes and a reduction in caffeine intake. Panic attacks may be alleviated by the use of relaxation techniques, breathing exercises, yoga and other physical therapies.

The rate of withdrawal should be appropriate to the needs of individual addict and will depend upon the severity of the addiction. In most addicts a withdrawal period of six to eight weeks is normal, but some will require withdrawal over a number of months and up to a year to ensure their physical and mental wellbeing. Those who are used to habitually taking large doses of benzodiazepines can usually tolerate larger reductions in their dose than those on lower daily doses.

Support groups led by former benzodiazepine abusers can help addicts of the drug to maintain a lifestyle free of benzodiazepines. One-to-one counselling may also be appropriate, especially in cases where former addicts suffer from confidence issues and low self-esteem, and have anxiety about speaking in front of others.

The rates of rehabilitation from benzodiazepine addiction is encouragingly high when the addict is motivated to stop, and when the withdrawal is managed is a gradual way with appropriate counselling.