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Benzodiazepines (Benzo’s)

What are Benzodiazepines?

Benzodiazepines (pronounced BEN-ZOH-DIE-AZ-A-PINS) are depressant drugs. Benzodiazepines, also known as “minor tranquillisers”, are prescribed by doctors to relieve stress and anxiety and to help people sleep. Some people use benzodiazepines illegally, to become intoxicated.

Like other depressants, benzodiazepines work by slowing down the activity of the central nervous system. In the short term, they can help with relaxation, calmness and relief from tension and anxiety. But they do not solve the problem that caused the anxiety in the first place and they can have a range of unwanted side effects.

What do they look like?

Benzodiazepines usually come in the form of tablets and capsules, in a range of colours and designs. They are generally stamped with their name and milligram quantity.

How are they used?

Medical uses

Benzodiazepines are prescribed as sedatives/hypnotics (to induce sleep) or anxiolytics (to relieve anxiety). They vary in how quickly they work and how long they last. They are also used to treat epilepsy, to relax muscles, to help people withdraw from alcohol, or as an anaesthetic before surgery.

Non-medical uses

Some people use benzodiazepines illegally to become intoxicated. They may use them when they can’t get heroin, when they are trying to get off heroin or to increase the effects of heroin. People who use stimulant drugs such as amphetamines (speed) or MDMA (ecstasy) may use benzodiazepines to help when they are “coming down” from a “high”, and to help them sleep.

Chemical and brand names

Benzodiazepines are known by their chemical (generic) names and their brand/trade names. In each case, these are exactly the same drug, usually made by different companies. There are over 24 different prescribed benzodiazepines, including:

Chemical nameBrand names
DiazepamValium, Ducene
OxazepamAlepam, Murelax, Serepax
NitrazepamAlodorm, Mogadon
TemazepamNormison, Euhypnos, Temaze

Effects of benzodiazepines

The unwanted negative effects of benzodiazepines vary according to dose.

Low to Moderate Doses

The immediate effects of low to moderate doses include mild impairment of thought processes, memory and coordination; drowsiness, tiredness and lethargy; dizziness; vertigo; and blurred or double vision. The person may experience a dry mouth, slurred speech and stuttering, tremors, nausea and vomiting, loss of appetite, constipation or diarrhoea. Feelings of euphoria or isolation and emotional depression may also occur.

Higher Doses

Higher doses can result in drowsiness, over-sedation and sleep. They may produce an effect similar to alcohol intoxication. Other effects can include confusion, slurred speech, poor coordination, impaired judgement, difficulty thinking clearly, loss of memory, blurred or double vision and/or dizziness. Mood swings and aggressive outbursts may also occur. The symptoms intensify as the dose increases. Feelings of jitteriness and excitability often become evident as the effects of large doses wear off.

Overdose

Very high doses of benzodiazepines can cause respiratory depression, unconsciousness or coma. Death rarely occurs from overdose of benzodiazepines alone, but deaths can occur if large doses are combined with alcohol or other drugs. Deaths can also occur from inhalation of mucus or vomit when a person is unconscious.

Bingeing

A “binge” is when a large amount of benzodiazepines is taken in one session, rather than as prescibed by a doctor. There is a strong possibility of overdosing and that a high level of benzodiazepine will remain in the bloodstream the day after a binge. This makes it dangerous to drive or operate machinery. If the binges are fairly close together, there is a risk of developing dependency on the drug.

Long-term Effects

The use of benzodiazepines over a long period of time (more than two to three weeks) should be carefully monitored by your doctor. Some of the health effects of using high doses of benzodiazepines in the long term include:

  • muscle weakness
  • skin rashes
  • weight gain
  • increased risk of accidents
  • increased risk of falling
  • sexual problems
  • menstrual irregularities
  • memory loss
  • confusion and diffculty thinking clearly
  • lethargy and lack of motivation
  • fatigue
  • drowsiness
  • difficulty sleeping and disturbing dreams
  • nausea
  • personality change and changes in emotional responses
  • anxiety
  • irritability, paranoia and aggression
  • depression.

Injecting Benzodiazepines

Injecting benzodiazepines can be very dangerous and can result in serious health problems. Most benzodiazepines are intended for oral use but some people inject them. Serious effects include:

  • collapsed veins
  • red, swollen, infected skin
  • amputation of limbs due to poor circulation
  • damage to organs
  • stroke, and even death.

Sharing needles, syringes and other injecting equipment can greatly increase the risk of contracting blood-borne viruses such as hepatitis Bhepatitis C and HIV (human immunodeficiency virus—the virus that causes AIDS).

Tolerance and Dependence

People who are physically dependent on benzodiazepines can develop tolerance to the drug. This can happen very quickly and means that more of the drug is required to get the same effect.

Dependence on benzodiazepines can be psychological or physical, or both. Dependence can occur after using them for a few months and is not related to the size or physical effect of the daily dose taken. Dependency can still develop for people on long-term, low doses.

People who are psychologically dependent feel as though they can’t cope without benzodiazepines. They crave the drug and find it very difficult to stop using it.

People who are physically dependent on benzodiazepines have become used to functioning with the drug present.

Withdrawal

If a dependent person suddenly stops taking benzodiazepines, or severely cuts down their dose, they may experience physical withdrawal symptoms as their body readjusts to functioning without the drug.

Withdrawal symptoms from benzodiazepines vary from person to person, but can be quite severe. Some people have no symptoms at all, while others may have symptoms lasting from a few weeks or months to a year. Symptoms tend to come and go, but all withdrawal symptoms eventually disappear as the body adjusts to functioning without the drug.

Withdrawal symptoms can include:

  • headaches
  • aching or twitching muscles
  • tremor
  • faintness or dizziness
  • sweating
  • nausea, vomiting and stomach pains
  • bizarre dreams
  • inability to sleep properly
  • fatigue
  • difficulty concentrating
  • anxiety and irritablity
  • altered perception
  • heightening of the senses of sight, touch, hearing, smell and taste.

Other less common withdrawal symptoms may include delirium, delusions, hallucinations, seizures and paranoia.

People who have been using benzodiazepines for more than a month should not suddenly stop taking them without seeing a doctor or health worker. A slow reduction in dose over time is recommended to reduce the severity of the withdrawal symptoms. If you suffer from anxiety and/or insomia keep in mind they may simply be withdrawal symptoms. If so, these symptoms will eventually cease.

Treatment Options

For people who use benzodiazepines for non-medical purposes, there are a number of drug treatment options. Some aim solely for the user to achieve a drug-free lifestyle. Others recognise abstinence as one option, with the overall aim of reducing harm/risks related to a person’s drug use.

Treatment is more effective if tailored to suit a person’s circumstances and usually involves a combination of methods. The different options include counselling, group therapy and supervised/home withdrawal.

Pregnancy and Breastfeeding

If you have been prescribed benzodiazepines, talk to your doctor if you are pregnant or breastfeeding.

Benzodiazepines taken during pregnancy cross the placental barrier and can affect the growth and development of the foetus, especially if the mother is taking more than the prescribed dose or taking benzodiazepines that have not been prescribed for her. High doses of benzodiazepines during pregnancy may lead to the baby being born with a temporary loss of muscle tone, poor feeding, drowsiness and a low temperature.

Benzodiazepines can be passed from mother to baby through breast milk and may have a sedative effect. The baby’s body cannot process these drugs quickly, and they can accumulate in high doses.

Preventing and Reducing Harms

If you are concerned about your dosage, talk with your prescribing health professional. There is no standard dosage suitable for everyone.

In the short term, benzodiazepines may help in getting through a difficult period of your life. However, when benzodiazepines are stopped, the problems will still be there. It is important to try and deal with those problems.

Make regular appointments with your health professional to review your medication and discuss possible alternatives.

There are many ways to deal with stress and anxiety without using benzodiazepines. Relaxation, stress management, counselling, a healthy diet and plenty of exercise all help. Talk to your doctor or contact your local community health service to find alternative ways of dealing with stress and anxiety.

If you are using benzodiazepines for non-medical purposes, and you are planning to stop using them, talk to a health professional and make sure you have medical support for a gradual withdrawal program.

What to do in a crisis

If someone overdoses or has an adverse reaction while using benzodiazepines, it is very important that they receive professional help as soon as possible. A quick response can save their life.

  • Call an ambulance. Dial 000. Don’t delay because you think you or the person might get into trouble. Ambulance officers are not obliged to involve the police.
  • Stay with the person until the ambulance arrives. Find out if anyone at the scene knows mouth-to-mouth resuscitation or cardiopulmonary resuscitation (CPR).
  • Ensure the person has adequate air by keeping crowds back and opening windows. Loosen tight clothing.
  • If the person is unconscious, don’t leave them on their back—they could choke. Turn them on their side and into the recovery position. Gently tilt their head back so their tongue does not block the airway.
  • If the person has stopped breathing, give mouth-to-mouth resuscitation. If there is no pulse, apply CPR.
  • Provide the ambulance officers with as much information as you can—what benzodiazepines were taken, how long ago and any pre-existing medical conditions.
  • Before using benzodiazepines, make sure you and your friends know what to do in a crisis.