Benzodiazepines
What are benzodiazepines?
Benzodiazepines have
been available since the 1960s and have since been used to treat problems such
as severe anxiety and insomnia. Before benzodiazepines, such conditions were
treated with barbiturates, which were commonly linked to fatal overdoses. They
are sometimes referred to as ‘benzos’ or BZD/BDZ. They should not be
confused with the more recently introduced drugs BZP and ‘benzo fury’.
There are a wide variety
of benzodiazepines, which differ in the balance of effects they have, and how
long they last. The most well-known types include diazepam (Valium), temazepam,
nitrazepam and others, usually with names ending in –pam or -lam. Flunitrazepam
(Rohypnol) is a benzodiazepine but due to suggestions that it has been used as
a ‘date rape drug’, it is now illegal in some European countries, outside of
medical use.
What are the different forms of
benzodiazepines?
Generally benzodiazepines
are swallowed in tablet form, which is probably the least risky way of taking
them. Very rarely some users may inject liquid benzodiazepine or snort crushed
tablets.
Not all
benzodiazepines used recreationally are diverted pharmaceutical products.
Illicitly manufactured benzodiazepine tablets are frequently being encountered
due to availability from the internet. These may resemble pharmaceutical
preparations but are as unreliable as any other drugs on the unregulated
market. The content of these preparations will vary and may not contain the
drug expected.
How do benzodiazepines work as drugs in the
body and brain?
Benzodiazepines are
depressant drugs and have a ‘quietening’ effect on certain parts of the brain.
This is why they are useful in treating conditions such as anxiety or panic
attacks where certain parts of the brain may be overactive.
Do benzodiazepines have any medical uses?
Because of their
sedative and calming effects benzodiazepines are used short-term to treat sleep
problems and anxiety disorders. They are also used to ease distress, panic and
fear.
Benzodiazepines relax
muscles and have anticonvulsant effects. They are useful in treating the
withdrawal effects of alcohol, where they work to ease the agitation as well as
preventing seizures, muscle spasms and shaking.
Benzodiazepines are
also used longterm, although there are greater risks from long-term use.
What are the effects of benzodiazepines?
All benzodiazepines
reduce anxiety, and 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 stronger, and
benzodiazepines can make a user slur, appear confused and lose consciousness
unexpectedly. They can cause amnesia, or ‘blackouts’, where the user later has
little or no memory of what has happened over a period of time.
Very occasionally benzodiazepines can have paradoxical effects. For instance, some people have become aggressive or violent when taking benzodiazepines. This is thought to be due to thedisinhibiting effects of the drug.
Very occasionally benzodiazepines can have paradoxical effects. For instance, some people have become aggressive or violent when taking benzodiazepines. This is thought to be due to thedisinhibiting effects of the drug.
What are the risks of benzodiazepines? Can
they be avoided or reduced?
If someone takes an
overdose of a benzodiazepine, they can suffer unpleasant and potentially
harmful effects. Overdoses can cause confusion, slurring, sleepiness, loss
of coordination and collapse. If someone has taken enough to become
unconscious, there is a risk of inhaling and choking on stomach contents which
can potentially be fatal, and breathing can sometimes be depressed, especially in children. However, lasting
harm or death from an overdose is very rare.
The danger of severe
harm and death is very much greater if a benzodiazepine is taken with other
sedative drugs such as alcohol, heroin or GHB.
In these combinations, breathing can be depressed and stopped.
Emergency medical
assistance should be sought when someone becomes unresponsive after taking
drugs.
Benzodiazepines
decrease control and impair judgment, making the risk of accidents much
higher. This means activities like driving under the influence of benzodiazepines is
potentially very dangerous.
Are there health conditions that make
benzodiazepines more dangerous?
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 them to people with impaired balance and coordination, who are at risk of falling or who may be severely injured if they do. It is also possible that long-term use of benzodiazepines could contribute to, or worsen, memory related problems or certain forms of dementia. This needs further scientific study as it is unclear if such effects would be reversed on stopping the drugs.
.
Taking benzodiazepines, particularly taking them regularly, may put someone at a greater risk of accidents. Doctors make a considered decision before prescribing them to people with impaired balance and coordination, who are at risk of falling or who may be severely injured if they do. It is also possible that long-term use of benzodiazepines could contribute to, or worsen, memory related problems or certain forms of dementia. This needs further scientific study as it is unclear if such effects would be reversed on stopping the drugs.
Mixing benzodiazepines with other drugs
Taking benzodiazepines
with depressant drugs increases the risk of depressing breathing. Additionally,
the effects of benzodiazepines may be masked if taken with a stimulant, which
can lead to an overdose if a lot of the drug is taken and then the stimulant
wears off. Certain medications (e.g. some antidepressants) may also interact
with benzodiazepines to increase sedative effects.
How addictive are benzodiazepines?
One-off or occasional
use of benzodiazepines is very unlikely to result in the development of
dependence. However, taking benzodiazepines regularly over a sustained period
can cause very serious physical and psychological addiction. In fact, doctors are advised not to
prescribe benzodiazepines for more than 4 weeks.
People who become
dependent on benzodiazepines may become tolerant to the drug’s effects and
experience withdrawal symptoms without it. 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
dependence.
What are the harms of benzodiazepine addiction
and withdrawal?
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 after being prescribed
them for a medical condition.
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, and 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, the drug 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.
What are the long term effects of
benzodiazepines on health and wellbeing?
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 or depressed). 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 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.
There is some evidence suggesting that long-term benzodiazepine may increase
the risk of dementia. However, other experts think that the
evidence of this is not yet convincing.
Benzodiazepine harm reduction advice
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 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 benzodiazepine. You should check whether this is
possible if taking a benzodiazepine.
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