What are Benzodiazepines?
Benzodiazepines are sedative drugs which have been used in medical contexts since the 1960s to treat severe anxiety (anxiolytics) and insomnia (hypnotics). They are sometimes referred to as ‘benzos’, ‘jelly’s’, or BZD/BDZ, not to be confused with BZP (benzylpiperazine) and ‘benzo fury’ (benzofurans).
Due to a wide variety of benzodiazepines varying in efficacy; each benzodiazepine can vary in duration being either short-acting or long-acting. The most well-known types include diazepam (Valium), alprazolam (Xanax), temazepam and nitrazepam. The names usually end in –pam or –lam.
Benzodiazepines are available as tablets, capsules, and suppositories containing a group of central nervous system depressants.
Very rarely, some users may inject liquid benzodiazepine or snort crushed tablets. These are more dangerous and faster routes of consumption and can lead to rapid and potentially fatal overdoses.
Not all benzodiazepines used recreationally are pharmaceutical products. Illicitly manufactured benzodiazepine tablets are frequently encountered due to availability from the internet. These may resemble pharmaceutical preparations, sometimes sold in blister packs, but are as unreliable as any other drug on the unregulated market. The content of these preparations will vary and may not even contain any of the desired drug. Drug testing kits are available to test drugs bought from unregulated markets.
Benzodiazepines potentiate the effects of Gamma-Aminobutyric Acid (GABA) on the brain and body via slowing nerve signalling within the central nervous system. GABA functionally depresses activity of the brain in areas that control memory, reasoning, and essential functions such as breathing. Therefore, benzodiazepines make the user feel relaxed and sleepy (hypnotic), reducing anxiety (anxiolytic) and causing muscle relaxation. This makes them very useful for treating conditions such as anxiety or panic attacks, where certain parts of the brain may be overactive.
Due to their sedative effects calming the nervous system, benzodiazepines are used short-term to treat sleep problems (hypnotics) and anxiety disorders (anxiolytics). They are also used to ease distress, panic, and fear.
Benzodiazepines relax muscles and have anticonvulsant effects, so are useful in treating the withdrawal effects of alcohol, where they work to ease agitation as well as preventing seizures, muscle spasms and shaking. Due to this anticonvulsant effect, it can be used for people with epilepsy.
Benzodiazepines are not often used long term due to an increase in risks when used over a sustained period leading to physical and mental addiction.
Benzodiazepines reduce anxiety, relax the mind and muscles, decrease alertness and concentration, and reduce coordination. Depending on the dose and the individual, benzodiazepines can cause cosy sleepiness, or calm chattiness. At higher doses, the sedating effects become increased, making a user’s speech slurred, cause confusion and can lead to a loss of consciousness. They can also cause amnesia, or ‘blackouts’, where the user later has little or no memory of what has happened over a certain time period.
Occasionally, benzodiazepines can have paradoxical effects (opposite effects to those desired). For instance, aggression, anxiety, delusions, and depersonalisation. These paradoxical effects are more common amongst children and older people. The exact mechanism of paradoxical effects is unknown; however, it is thought that there is a genetic link which makes a person predisposed to experiencing these effects, as well as a link to a history of alcoholism.
Using benzodiazepines poses risks to both physical and mental health.
If someone is overdosing from benzodiazepines, they can suffer unpleasant and potentially harmful effects. Overdoses can lead to confusion, slurring of speech, sleepiness, depressed breathing, loss of coordination and consciousness. If someone has become unconscious, there is a risk of inhaling and choking on stomach contents which can be fatal. Severe, lasting harm or death from a benzodiazepine overdose is rare.
However severe harm and death is increased when benzodiazepines are taken with other sedatives such as alcohol, heroin or GHB. In these combinations, breathing can be depressed or stopped completely.
Emergency medical assistance should be sought when someone becomes unresponsive after taking drugs.
To reduce the risk of overdosing on benzodiazepines, try to carefully monitor how much you are taking. Starting with just half (or a quarter) of a dose and seeing how you feel; this can prevent you from taking too much at once. It is a good idea to have someone who you trust around when taking benzodiazepines so that they can help you if you experience any adverse effects. Reagent test kits are sold online which can confirm or rule out the presence of a benzodiazepine. These are useful if the benzodiazepines have been illicitly obtained.
Benzodiazepines decrease control and impair judgment, meaning activities like driving under the influence of benzodiazepines can potentially be very dangerous.
Use of the benzodiazepine, Rohypnol (flunitrazepam), has been implicated with sexual assault crimes. It’s thought that victims’ drinks have been spiked with Rohypnol, making them very drowsy or even causing them to fall unconscious.
The risks of depressed breathing caused by benzodiazepines are increased in people with conditions such as muscle weakness (e.g. myasthenia gravis), sleep apnoea, or lung disease/breathing disorders.
Taking benzodiazepines, particularly taking them regularly, may put someone at a greater risk of accidents. Doctors make a considered decision before prescribing patients with impaired balance and coordination, who may be severely injured due to their disabilities. It is also possible that long-term use of benzodiazepines could contribute to, or worsen, memory related problems or certain forms of dementia. Further scientific study is needed as it is unclear if such effects would be reversed if someone ceased to use benzodiazepines.
Additionally, the effects of benzodiazepines may be masked if taken with a stimulant. This can lead to overdose if the user consumes more benzodiazepines due to not initially feeling the effects.
Certain medications (e.g. some antidepressants) may also interact with benzodiazepines to increase sedative effects.
One-off or occasional use of benzodiazepines is unlikely to result in the development of dependence. However, physical, and psychological addiction can occur while taking benzodiazepines regularly over a sustained period. In fact, benzodiazepines are not normally prescribed for more than 4 weeks at a time.
People who become dependent on benzodiazepines may become tolerant to the drug’s effects, leading them to take increasingly higher doses. Dependency also leads people to experience withdrawal symptoms which include nausea, confusion, headaches, anxiety, and dizziness. Users may crave the drug and feel unable to cope without it. The longer the drugs are taken, the higher and more regular the dose and the stronger the benzodiazepines, the higher the risk of developing a dependence.
A period of sustained dependence on any drug can be debilitating and prevent people from working and leading an active life. It may also cause mental and physical harm and benzodiazepine withdrawal can be very unpleasant.
Long term use of benzodiazepines is often accompanied with the use of other drugs, such as alcohol and opioids. This is because some users may feel that benzodiazepines enhance the effects of a drug, or lessen the effects of drug withdrawal/comedown, or both. Those who solely use benzodiazepines outside of medical use often do so after becoming dependent on them having been prescribed them by a doctor.
Acute withdrawal effects for some benzodiazepines can be severe, although for many they will be milder. Acute withdrawal effects include anxiety, increased heart rate and blood pressure, shaking, insomnia and sensitivity to sound/light. Very severe withdrawal can cause symptoms that require intensive care, such as seizures. Someone who has been taking a benzodiazepine regularly for a sustained period should stop under the supervision and guidance of a doctor. Abruptly stopping use can be harmful so it is often better to taper use gradually before stopping entirely. To do this safely, professional advice is recommended.
Potential effects of long-term benzodiazepine use include anxiety, depression, and insomnia. These effects may last for months, depending on how dependent a person was on the drug, which drug was used, the length of time used, untreated on-going psychiatric conditions, as well as other personal factors such as why the drug was initially prescribed or used illicitly.
It is important to speak to medical professional while coming off benzodiazepines as they can prescribe medication to assist in the management of withdrawal symptoms as well as providing mental health support.
There are possible harms of long-term benzodiazepine use, although not everyone experiences problems with long term use. Specific harms that could be caused by long term benzodiazepine use include lack of energy, sleep problems, impaired memory, and changes in personality (becoming more aggressive, for example). Long term benzodiazepine use is also associated with anxiety related mental health problems such as panic disorder or social phobia. This may be because long term use causes the brain and body to become reliant on the drug’s anxiety-relieving effects. It may therefore be particularly risky for people with depression/anxiety disorders to take benzodiazepines long term; due to benzodiazepines paradoxical effects.
There is some evidence suggesting that long-term benzodiazepine use may increase the risk of dementia. However, other experts think that the evidence of this is not yet convincing.
How much are you taking, how often?
The occasional medical or recreational use of benzodiazepines has a relatively low risk of harm. However, benzodiazepine dependence and withdrawal can develop after a few weeks of use and can cause considerable harm to a person’s quality of life and health. If you develop tolerance to any of the effects of a benzodiazepine, this should be taken as a warning sign that the drug may be harmfully affecting your body and brain.
Are you taking them with anything else? Mixing drugs is risky.
Drug effects are unpredictable, but mixing drugs makes the effects on your body and mind even harder to control. Deaths involving benzodiazepines generally involve other drugs too. It is particularly dangerous to combine a benzodiazepine with another drug that can depress breathing such as alcohol, heroin (or any opioid) or GHB. Additionally, if someone is taking antidepressants or even antihistamines, these may increase the effect of the benzodiazepines. Grapefruit juice can do the same with a few types of benzodiazepines. You speak to your GP about drug interactions when first starting benzodiazepines.
What to do if someone is having an overdose:
- Check if the person is okay
- Move the person into the recovery position
- Call 999
- Stay with them until the ambulance comes
- Let the medical team know what they have taken if you know