What they are

Benzodiazepines are prescription medicines most commonly used to treat anxiety and sleep disorders. Doctors may also prescribe them as muscle relaxants, or to treat epilepsy, alcohol withdrawal or panic disorders. Some people use benzodiazepines illegally to experience their effects and become intoxicated.

Benzodiazepines are a depressant. They work by slowing down the messages travelling around the central nervous system. This makes the user feel relaxed and calm, but tolerance builds quickly and the dosage required to deliver the same effect increases. For this reason benzodiazepines are intended to provide short-term, temporary relief, while the underlying causes of the anxiety or sleep disturbance are treated.

Benzodiazepines are prescribed in tablet form and come in a variety of shapes, sizes, and colours. There are many types and brand names of benzodiazepine. These are the ones commonly prescribed in New Zealand:

Once taken benzodiazepines take effect within 30 minutes. Lasting effects depend on the type of benzodiazepines used, the dosage, the condition being treated, and the presence or absence of other drugs.

Benzodiazepines are sometimes used illegally (without a prescription) to become intoxicated or as a substitute for opiate drugs when these are unavailable or when a person is trying to stop using opiates. They are sometimes used with opiate drugs to enhance their effects, and some people use benzodiazepines to help alleviate the ‘come down’ from stimulant drugs like amphetamines or MDMA (ecstasy) and to help them sleep.

Slang
Benzos, Tranxs, Downers, Sleepers

Health effects

Short-term effects

Medically, benzodiazepines are prescribed for between two weeks and one month. Benzodiazepines should be used for only a short time in order to avoid developing a tolerance to the drug and experiencing withdrawal symptoms when use is stopped.

If recommended doses are administered, for the correct time, the following short-term effects include:

• relaxation
• calmness
• relief from tension and anxiety
• drowsiness and sleepiness, leading to an induced state of sleep.

When benzodiazepines are taken at higher doses, effects similar to those of alcohol can be produced including:

• drowsiness and sleepiness, leading to an induced state of sleep
• over-sedation
• cognitive and coordination impairment
• mood swings
• aggressive outbursts.

It is common for recreational users to take high doses of benzodiazepines as they are not always aware of recommended dosages, and are administering the drug to achieve a state of intoxication.

Long-term effects

Long-term use (exceeding one month) of benzodiazepines is not recommended and should be monitored by a doctor. Long-term use of benzodiazepines may cause:

• drowsiness and sleepiness, leading to an induced state of sleep
• lack of motivation
• unclear thoughts, memory loss
• behavioural and personality changes
• anxiety, irritability or aggression
• difficulty sleeping and disturbing dreams
• nausea, headaches
• skin rash
• menstrual and sexual problems
• greater appetite, weight gain
• lack of coordination, vulnerability to accidents
• depression
• slurred speech.

Long-term use of benzodiazepines commonly causes similar conditions to those which the drug has been prescribed to relieve.

Any adverse effects experienced while on benzodiazepines should be discussed with a health professional. Stopping long-term or heavy use of benzodiazepines – whether by a recreational user or someone using them for medical reasons – will require medical attention to help prevent withdrawal syndrome or a relapse to the underlying condition.

Dependence, addiction and overdose risk

Dependence and addiction

Benzodiazepine use may lead to the development of psychological and physical dependence. People who use benzodiazepines for more than a month often find they need to substantially increase their dose in order to achieve the same results.

Risk of dependence and addiction increases with dose and length of use, particularly in people with a history of alcoholism and/or drug abuse.

Discontinuation after heavy or long-term use of benzodiazepines, can lead to the user experiencing withdrawal symptoms if:

• they become tolerant to their prescribed dose
• they reduce their dose too quickly
• they stop using their drugs abruptly
• recreational use is suddenly ended.

Withdrawal symptoms are both physical and psychological and can include:

• headaches, nausea
• sweating, shakes
• muscle aches and pains
• visual disturbances, and hallucinations
• fatigue
• indigestion
• diarrhoea
• numbness
• anxiety, panic attacks, depression
• confusion
• rapid mood changes
• memory loss
• changes in perception
• hyperactivity
• nightmares
• palpitations. 

It is important that people who are planning to stop using benzodiazepines seek medical advice, especially if they have been using them for more than a month.  A doctor or other medical professional will offer advice on how to avoid withdrawal symptoms or a relapse of the existing condition.

Overdose

High doses of benzodiazepines can lead to overdose resulting in dangerously slowed breathing, unconsciousness and coma. Death from benzodiazepine overdose is rare, but is more likely to occur when it is used with alcohol or other drugs.

Law and penalities

Benzodiazepines are classified as Class C controlled drugs under the Misuse of Drugs Act 1975.

• Penalties for the illegal importation, manufacture or supply of benzodiazepines are up to eight years imprisonment and up to seven years imprisonment for conspiracy to commit an offence.
• Possession of non-prescribed benzodiazepines can result in up to three months imprisonment, a $500 fine, or both.

Drug trends

Benzodiazepines have been widely misused in New Zealand, although only recently have use trends been documented.

According to the latest Drug Use in New Zealand Survey 2007/2008 published in 2009: 2.2 percent of all adults aged 16 to 64 years had used prescription sedatives for recreational purposes at some point in their lifetime. This equates to about 57,200 people in New Zealand.

• Overall, 0.6 percent of adults aged 16 to 64 years had used in the last 12 months, equating to about 16,100 people, with 59 percent of those using at least weekly in the past year. 
• A third had first used when they were aged 21-years or older, with men significantly more likely to have used prescription sedatives for recreational purposes.
• Benzodiazepine use is more common amongst intravenous drug users. Intravenous use of these drugs is associated with a greater frequency of injecting with used needles and other risky injecting behaviour. These users are at greater risk of transmitting disease, poly-drug use and overdose. 
• International data suggests that benzodiazepines are amongst the most widely diverted pharmaceutical products destined for illegal markets and misuse.

Reducing the harm

The Drug Foundation’s message is clear: no drug use is the safest drug use. However, we know there will be occasions when people ignore warnings and use drugs in a dangerous manner. To help keep communities safe we therefore provide information about proven methods of drug harm reduction.

It can be dangerous to combine benzodiazepines with other central nervous system depressants like alcohol or opiates. These combinations can lead to unconsciousness or, in high doses, death. People taking benzodiazepines should avoid taking alcohol and other drugs.  If a person becomes unconscious after taking benzodiazepines they should be rolled into the recovery position to avoid them choking.

Benzodiazepine tablets or capsules are intended for oral use only.  However some people inject benzodiazepines which can be very dangerous and has the potential to cause serious health problems.

Health problems associated with injecting benzodiazepines include:

• collapsed veins
• clotting of veins
• red, swollen, infected skin
• amputation of limbs due to poor circulation
• stroke or even death.

Sharing injecting equipment exposes the user to the risk of blood borne viruses like hepatitis B, hepatitis C, and HIV (human immunodeficiency virus – the virus that causes AIDS).

To find a list of needle exchange locations click here www.needle.co.nz

If you have been taking benzodiazpines for an extended period of time (a month or more) you should seek medical advice before stopping or reducing use. A medical professional will help you to manage any possible withdrawal symptoms.

How to get help

If you feel you or anyone you know needs help, there are a number of treatment organisations you can contact in strict confidence.

DrugHelp is a uniquely New Zealand website for people looking for help with their own or someone else’s drug use. DrugHelp shares the stories, experiences, insight and hope of people who have been there – people who have abused drugs and found a way through. www.drughelp.org.nz

The Alcohol Drug Helpline (0800 787 797) provides free and confidential support for any person concerned about their own or another person's alcohol or drug use. When you call you will talk to an experienced counsellor who is there to listen. You can trust the helpline to provide you with confidential and non-judgemental help when you need it.

The helpline is open from 10am–10pm, every day.

For help or advice about intravenous drug use visit your nearest Needle Exchange. More information and a list of locations can be found at www.needle.co.nz

What tio do in a crisis

If someone overdoses, becomes unwell, or has a bad reaction to benzodiazepines or any other drug, do not hesitate to get emergency medical assistance. A quick response could save their life:

• Dial 111 and ask for Ambulance. Do not wait to see if the person comes right on their own.

• Stay with the person until medical help arrives. Find out if anyone on the scene knows mouth-to-mouth resuscitation and/or cardiopulmonary resuscitation (CPR). Have them stand by in case the person stops breathing or you can no longer detect a pulse.
• Ensure the person has sufficient air. Ask crowds to stand back, open windows, and loosen any tight clothing.
• If the person is unconscious roll them onto their side into the recovery position so they won’t choke if they vomit. Tilt their head back slightly to ensure their tongue does not obstruct their airway.
• If the person stops breathing apply mouth-to-mouth resuscitation, if you cannot detect a pulse begin CPR.
• When the ambulance arrives give the medics as much information as possible – what drugs were taken, when they were taken, and whether the person has any existing medical conditions.
• Before you go out, know what to do in a crisis.

Links

A list of relevant links to further information and resources about benzodiazepines:

www.moh.govt.nz/moh.nsf/indexmh/drug-use-in-nz-key-results-of-the-0708-nzadus Drug Use in New Zealand: Key results of the 2007/08 New Zealand Alcohol and Drug Use Survey.

www.medsafe.govt.nz/ Medsafe New Zealand Medicines and medical devices safety authority.

www.needle.co.nz New Zealand Needle Exchange Programme

www.tranx.org.nz TRANX is a drug treatment service that specialises primarily in benzodiazepines (benzo) addiction/dependence.

www.drughelp.org.nz Uniquely New Zealand website that helps people who use drugs, and their loved ones, find solutions to the problems drug use has caused.