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, then to 1.4 million in 2019 (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.

Tolerance can develop after just 6 months of use, but it is possible to become physically dependent sooner. One study estimates that up to 44% of chronic users become dependent.

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. Symptoms can last from a few weeks to a year.

“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.

Deaths

Even though prescriptions for benzodiazepines have been falling, deaths where a benzodiazepine was implicated have increased over the past decade across the UK, consistent with an increased role of illicitly manufactured benzodiazepines according to Advisory Council on the Misuse of Drugs’ review in 2020. The ONS report Deaths related to drug poisoning in England and Wales: 2020 registrations states that there have been increasing numbers of deaths involving benzodiazepines in 2020 (a rise of 19.3% when compared with 2019; from 399 to 476 deaths).

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.

According to Seizures of drugs in England and Wales, financial year ending 2021, 40% of all seizures of Class C drugs involved benzodiazepines.

Prevalence

 The 2018/19 Home Office survey of drug use estimated that in the last year 0.4% of adults aged 16 to 59 had taken tranquillisers in the last year.

Prescribing trends

PHE’s analysis published in September 2019 shows that 1.4 million (3%) of people received a prescription for a benzodiazepine in the UK. The latest numbers for benzodiazepine prescribing can be found on OpenPrescribing, a website where you can search for drugs to see how many items are prescribed in the UK over time.  

In the US, according to statistics from the National Institute on Drug Abuse (NIDA)’s 2020 Misuse of Prescription Drugs Research Report 2.2% (or about 6.2 million people) reported misusing prescription tranquillisers or sedatives in the past 12 months.

Prevalence of recreational use

Among street drug users, benzodiazepines have long been part of the drug ‘mix’ along with heroin, crack, alcohol and more recently synthetic cannabinoids generally known as spice. Traditionally, the sources of benzodiazepines on the street have derived from diverted medical prescriptions or simply prescriptions prescribed to users themselves.

However, in recent years, a range of illicitly produced benzodiazepines have become widely available across the UK. Not all these variants are controlled under the Misuse of Drugs Act and they often contain dangerous levels of the drug. For more information see Novel Benzodiazepines: A review of the evidence of use and harms of Novel Benzodiazepines, (PDF) ACMD, 2020. In July 2020, MHRA issued an alert on Evidence of harm from illicit or fake benzodiazepines. This alert advised on the availability and harm from illicit drugs sold as benzodiazepines, particularly when used in conjunction with alcohol and other drugs with a respiratory depressant effect, including gabapentinoids and opioids.

In June 2021, The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)  published an in-depth report providing a review of the current body of knowledge regarding new benzodiazepines that are monitored by the EU Early Warning System.

Read more

DrugWatch Information Sheet: Etizolam

BENZOS Guide by CREW  – This guide covers usage, effects, safety and help (PDF) – Published November 2020

Updated May 2022