Benzodiazepines

Tranquillisers, minor tranquillisers, tranx, downers, benzos

Diazepam (Valium), vallies, blues

Alprazolam (Xanax)

Lorazepam

Temazepam, jellies, eggs

Flunitrazepam (rohypnol), roofies, R2

Phenazepam, kronic, bonsai

Nitrazepam, Oxazepam, Chlordiazepoxide (Librium), Lorprazolam

 

What are Benzodiazepines?

Benzodiazepines are the most commonly prescribed sedative drugs. They may be short or long acting. Short acting forms such as temazepam and Rohypnol are used as sleeping tablets (hypnotics) while longer acting forms, such as lorazepam and diazepam, are used in the management of anxiety (anxiolytics).

Since these drugs begin to work within 30-90 minutes they are useful for the quick relief of severe anxiety symptoms.

Other medical uses for benzodiazepines include as a muscle relaxant, as a pre-operative relaxant, for epilepsy and mania, and in treating alcohol and opiate withdrawal.

Valium is the most widely used benzodiazepine in the UK. In addition to prescribed medical use, benzodiazepines are also used recreationally in the UK.

How they work

Benzodiazepines increase the levels of a brain neurotransmitter called GABA (Gabba Amino Butyric Acid). GABA has a calming effect on the brain.

History

Tranquillisers were first manufactured in the 1960s as non addictive drugs which could be used to treat anxiety and insomnia. They were developed as a safer alternative to barbiturates which had proven to be addictive and could be highly dangerous in overdose.

Although many people, particularly women, suffered side effects and dependence, the prescribing of tranquillisers continued to grow for over 20 years. It was not until the late 1970s that these problems were openly acknowledged. Prescriptions for tranquillisers fell from just over 30 million in 1979 to around 11 million in 2012 (see prevalence section below).

Benzodiazepines have a long history of recreational use. They are taken for their relaxing and sedating properties.

Effects/risks

Tranquillisers are depressant drugs which slow down people’s reactions and can make them feel drowsy, lethargic and forgetful. They can also lead to problems concentrating, headaches, vertigo and a loss of libido.

Benzodiazepines relieve anxiety and tension and can make people feel more calm and relaxed. Effects begin around 30 minutes after taking and can last for up to 6 hours.

“It’s like a dream state. It gets you away from it all. It cushions you so you don’t worry or care anymore. You don’t really know what is going on”.

Doctors now recommend that patients should not be on benzodiazepines for longer than four weeks as the drugs can become addictive and tolerance can develop so that increasing amounts are needed to get the same effect.

It is estimated that around 40% of people taking these drugs for more than 6 weeks will become addicted. Withdrawal can lead to symptoms such as intense anxiety, nausea, insomnia, irritability, dizziness and headaches. Sudden withdrawal from high doses can be very dangerous and result in confusion, hallucinations and convulsions. Many people find it very difficult to give up tranquillisers and may need a gradually reduced dosage to do so.

“Temazepam took over my life. It creeps up on you and is very addictive. I started using to bring me down from acid trips to make me feel normal. I liked them and started to use more and more. And that’s when the problems really started because I couldn’t leave them alone”.

Rohypnol (flunitrazepam) is often used in helping sleep disorders. It is sometimes referred to as the date rape drug. This is due to its use being implicated in sex crimes where a victim’s drink is spiked with the drug, making them very drowsy or knocking them out so they’re either unaware of or unable to prevent a sexual assault.

There have been reports of people fatally overdosing on tranquillisers, especially when also drinking alcohol. People with renal impairment have an increased sensitivity to benzodiazepines. There is a risk of neonatal withdrawal symptoms if benzodiazepines are used during pregnancy.

Harm reduction

  • The effect of slowing reactions and making people drowsy can make accidents more likely. It can be dangerous to drive while on tranquillisers.
  • As with all drugs it is best to take benzodiazepines with people you trust rather than on your own and to start with a small dose and wait.
  • Alcohol can interact with benzodiazepines so is best avoided, as is using different types of benzodiazepines together.
  • Crushing down tranquillisers in a solution is very dangerous as the tablets often contain chalk which can lead to collapsed veins.
  • It is best not to take benzodiazepines for more than 4 weeks due to the tolerance and dependence that can develop.
  • Benzodiazepines should never be stopped suddenly. Always reduce their use gradually with your doctor’s supervision.

The law

All benzodiazepines are Prescription Only Medicines under the Medicines Act. This means they can only be legally supplied by a pharmacist in accordance with a doctor’s prescription.

They are also controlled as a class C drug under the Misuse of Drugs Act. The maximum sentence for possessing is 2 years imprisonment. The maximum sentence for supplying to someone else and for production is fourteen years and a fine.

In practice maximum sentences are rarely used, for more information please see the sentencing page on the Release website.

Prevalence

Prescribing trends

According to the MHRA (Medicines and Healthcare Regulatory Agency) Primary-care prescribing of benzodiazepines in England has been relatively constant between April 2008 and April 2012, ranging between 10.9 and 11.1 million prescriptions annually.

The prescribing of benzodiazepine hypnotics (flurazepam, loprazolam, lormetazepam, nitrazepam, and temazepam) has declined from 2008 to 2012, while that of benzodiazepine anxiolytics (alprazolam, chlordiazepoxide, lorazepam, and oxazepam) has increased slightly, but prescribing has increased most for benzodiazepines that can be used for other purposes (clobazam, clonazepam, diazepam, and midazolam).

Prevalence of recreational use

According to a study from November 2014 published in the British Journal of Psychiatry, of 1500 respondents 7.7% (n = 116) had misused one or more benzodiazepines. Almost 15% of those misusing at least one of these drugs did so once weekly or more often. The main reasons reported for their use were to help sleep (66.4%), to cope with stress (37.1%) and/or to get high (31.0%). A total of 31% obtained the medications from multiple sources; healthcare professionals (55.2%) and friends/family (39.7%) most commonly.

There is no known illicit manufacture of benzodiazepines. The benzodiazepines which circulate on the illicit market are diverted from legitimate clients either by over-prescription, that is to say individuals selling on part, or all, of their legitimately prescribed drugs, or by theft from pharmacies, hospitals or retailers.

Updated December 2016