Do You Know... Benzodiazepines

Generic and trade names: alprazolam (Xanax), clonazepam (Rivotril), diazepam (Valium), flurazepam (Dalmane), lorazepam (Ativan), temazepam (Restoril), triazolam (Halcion) and others
Street names: benzos, tranks, downers

What are they?

Benzodiazepines are a family of prescription drugs that are used mainly to relieve anxiety and to help people sleep. They are sedative drugs, which affect the activity in certain parts of your brain, resulting in a calming effect.

Other uses of benzodiazepines include:

inducing sedation for surgical and other medical procedures
treating alcohol withdrawal
controlling seizures
relaxing skeletal muscles, such as those of the back and neck.

Some people who abuse other drugs use benzodiazepines too, either to enhance the effect of other sedative drugs, such as opioids and alcohol, or to ease the agitation caused by drugs that have stimulant effects, such as ecstasy or cocaine. Taking benzodiazepines in combination with other drugs can be dangerous.

Because they are safer, benzodiazepines have replaced older drugs with similar effects, such as barbiturates. Fourteen benzodiazepines are currently available in Canada, by prescription only.

Where do benzodiazepines come from?

All drugs in this family are chemical compounds that are made in the laboratories of pharmaceutical companies.

What do benzodiazepines look like?

Benzodiazepines are usually in the form of tablets or capsules, in various colours, which are taken orally. A few of them are also prepared as a solution for injection.

Who uses benzodiazepines?

In 2009, about nine per cent of Canadians reported using sedative or tranquilizer drugs such as benzodiazepines at least once in the past year. Of those who used these drugs, 1.7 per cent used them to get high.

A 2009 survey of Ontario students in grades 7 to 12 reported that 1.6 per cent had used sedatives or tranquilizers at least once in the past year.

How do benzodiazepines make you feel?

Benzodiazepines can relieve mild to moderate anxiety and make you feel relaxed and calm. They can also relieve insomnia and severe states of emotional distress.

A potential side-effect of benzodiazepines is that they may make you drowsy and/or clumsy. Taking benzodiazepines can also make it more difficult to learn and remember new information, and to perform some physical and mental tasks. Most often, learning, memory and performance return to normal once the effect of the drug has worn off.

Other side-effects that may occur include confusion, disorientation, amnesia, depression, dizziness and—extremely rarely—agitation and hallucinations.

The way benzodiazepines affect you depends on many factors, including:

what condition the medication was prescribed to treat, and the severity of the condition
the type of benzodiazepine you take
how much you take and how often you take it
how long you’ve been taking it
if you’ve taken any alcohol or other drugs (illegal, prescription, over-the-counter or herbal).

How long does the feeling last?

When benzodiazepines are taken by mouth, their effects may be felt within 30 to 40 minutes or within two to four hours, depending on the type taken. Most benzodiazepines have effects that are felt for several hours. The time it takes to eliminate these drugs from the body also varies depending on the type taken, and ranges from days to weeks.

Are benzodiazepines dangerous?

When used appropriately, as prescribed by your physician, benzodiazepines are safe. However, there can be dangers associated with the use of these drugs:

Benzodiazepines can affect your ability to drive a vehicle or operate equipment safely, and can increase the risk of collision, especially if taken in combination with alcohol or certain other drugs.
When used to induce sleep, benzodiazepines may have some “hangover” effects, such as morning and daytime drowsiness, which may impair your ability to perform tasks requiring alertness.
Sensitivity to the effects of benzodiazepines increases with age. When older adults take these drugs, even as prescribed, they may become confused and have reduced muscle co-ordination, putting them at greater risk of falls, hip fractures and automobile accidents.
Taking benzodiazepines regularly for more than a few weeks can result in addiction.
Any regular use of benzodiazepines should be reduced gradually, with guidance from a physician or pharmacist, to minimize withdrawal symptoms.
Stopping high-dose regular use of benzodiazepines abruptly may cause severe withdrawal symptoms. Medical help may be required.
Dying from an overdose of benzodiazepines alone is rare. However, the risk increases when benzodiazepines are combined with other sedatives, such as alcohol or barbiturates, or with medications containing codeine or other opioid drugs. Combined use of benzodiazepines and methadone is particularly dangerous. Signs of possible overdose include slurred speech, confusion, severe drowsiness, weakness and staggering, slow heartbeat, breathing problems and unconsciousness.
The risk of birth defects from taking benzodiazepines while pregnant is not known, though it is thought to be very small. If benzodiazepines are used regularly close to delivery, the baby may be born drowsy or may have withdrawal symptoms such as restlessness and feeding problems.
Small amounts of benzodiazepines are passed from the mother to the baby through breast milk. This may cause drowsiness in the baby.
Certain benzodiazepines have been associated with sexual assault, or “date rape.”

Are benzodiazepines addictive?

When used as prescribed, on occasion or daily for a few weeks, benzodiazepines have a low risk of addiction. This risk increases, however, when benzodiazepines are taken regularly for more than a few weeks, especially when they are taken in higher-than-normal doses.

Signs of addiction include craving the effects of the drug, taking more of the drug than intended and continuing to use the drug despite the problems it may cause.

Addiction may develop with or without physical dependence. Signs of physical dependence include tolerance and withdrawal.

People are said to have developed tolerance to the effects of a drug when the same dose, taken over time, no longer has the desired effect. Some people who develop tolerance may take higher and higher doses to feel the same intensity of effect as when they started taking the drug. This use increases the risk of addiction.

People who use benzodiazepines for insomnia often develop tolerance to the sleep-inducing effects within a few weeks of regular use; however, tolerance does not usually develop with occasional use. Tolerance to the anxiety-relieving effects is less likely to develop. Tolerance to the effects of one type of benzodiazepine leads to tolerance to other benzodiazepines, and to other drugs with similar effects, including alcohol.

People who are physically dependent on benzodiazepines may experience withdrawal symptoms if they stop using the drug. The severity of withdrawal symptoms depends on the type of benzodiazepine used, the amount used, the length of time it is used, and whether the drug is stopped abruptly. Withdrawal symptoms can include headache, insomnia, tension, sweating, difficulty concentrating, tremor, sensory disturbances, stomach upset and loss of appetite.

Severe withdrawal symptoms from regular use of benzodiazepines in high doses may include agitation, paranoia, delirium and seizures.

Long-term regular use of benzodiazepines should be reduced gradually, with medical supervision.

What are the long-term effects of taking benzodiazepines?

When prescribed by a physician, taken at recommended doses on occasion or for a few weeks, and not taken with alcohol or certain other medications, benzodiazepines are safe medications. Long-term use of benzodiazepines, especially by older adults, may have lasting effects on the brain.