BENZODIAZEPINES: Harm reduction information and advice

The use of benzodiazepines  is increasing.More and more people are using benzodiazepines to help with anxiety, stress and sleep problems.

Most benzodiazepines are obtained legitimately, with a prescription, and their use monitored by a doctor or other health professional. 

But an increasing number of people are using illegally obtained so-called ‘street benzos’ or ‘street Valium’ - either diverted from legitimate prescriptions or purchased online.

WHAT ARE BENZODIAZEPINES?

Benzodiazepines are sedative and anti-anxiety drugs that are used to treat various conditions such as anxiety, insomnia, muscle spasms, epilepsy

Benzodiazepines work by increasing the effect of a brain chemical called GABA (gamma-aminobutyric acid). GABA reduces brain activity and has a calming effect.

They are also misused, and when used at the same time as alcohol and other drugs, the chances of a fatal overdose is increased.

TYPES OF BENZODIAZEPINES?

There are different types of  benzodiazepines, which include:

• Alprazolam (Xanax)
• Chlordiazepoxide (Librium)
• Diazepam (Valium)
• Lorazepam (Ativan)
• Flubromazolam
• Flurazepam (Dalmane)
• Phenazepam
• Temazepam (Restoril)

Dosing

Different benzodiazepines will stay in your body for different lengths of time - depending on their half-life. Half-life is the time it takes for your body to break down and remove (metabolise) half the drug. 

Diazepam has a half-life of around 20 hours - so after 20 hours, you will still have half the dose in your body. Using again can lead to increased levels and an increased chance of overdose.

Remember, not all benzodiazepines are the same. 10mg of one benzodiazepine isn’t necessarily the same as 10mg of another. 

Their effects will feel different, as will the time they take to start working and how long the effects last.

SIDE EFFECTS

Not everyone who takes benzodiazepines will feel side effects. but those that do may experience:

Common side effects include:

• drowsiness
• light-headedness
• confusion
•  unsteadiness on your feet 
• dizziness
• slurred speech
• muscle weakness
• memory problems
• constipation
• nausea (feeling sick)
• dry mouth
• blurred vision

Less common side effects include:

• headaches
• low blood pressure
•  increased saliva production
• digestive disturbances
• rashes
• sight problems (such as double vision)
• tremors (shaking)
• changes in sexual desire
• incontinence (loss of bladder control)
• difficulty urinating

Disinhibition

Benzodiazepines are normally prescribed to help reduce anxiety and calm people down, but they can have the opposite effect on a small number of people. 

They can cause dis-inhibiting and risky behaviour, particularly when mixed with alcohol or other drugs.

Behaviour can include:

• acute excitement
• altered mental state
• increased anxiety 
• vivid dreams 
• hyperactivity
• sexual dis-inhibition
• aggression
    

MENTAL HEALTH

Links have been noted between benzodiazepine use and depression and, in some cases, the emergence of suicidal thoughts.

The evidence suggests that higher benzodiazepine dosages are associated with an increased risk of depression in certain groups of people and that reducing or discontinuing use can help deal with the feelings.

If you experience any of these feelings or are thinking about changing the way you use a benzodiazepine, you must consult your GP, keyworker, or other health professional.

STREET BENZOS/DIAZEPAM

Illicit or fake benzodiazepines, often called ‘street benzos’ or ‘street Diazepam’, are benzodiazepines bought online or obtained without a prescription.

They come in various sizes and colours and are packaged in blister packs or pill containers designed to make them look safe and legitimate. Markings can include ‘DAN 5620’ (on one side) and ‘10’ (on the other), ‘T-20’, ‘TEM 20’, ‘Bensedin’ and ‘MSJ’.

Street benzodiazepines are unpredictable in content and potency and often contain unknown substances or substances that are dangerously stronger than that displayed on the packaging.

The unpredictable content and potency make street benzodiazepines particularly dangerous and are causing an increase in overdose, hospitalisation and deaths.

COMBINING BENZOS WITH DOWNER DRUGS IS DANGEROUS.

Using benzodiazepines with other downer drugs, such as alcohol, GHB and opioids, is very dangerous. 

Both types of drugs suppress breathing, and when used together, smaller amounts of each kind of drug is needed to increase the risk of a fatal overdose.

Alcohol

Smaller amounts of alcohol and benzodiazepines are needed to cause an overdose when used together. 

Combining alcohol and benzodiazepines can also result in poor decision-making, blackouts, and an inability to control one’s emotions, resulting in hostile or aggressive behaviour.

GHB/GBL

Benzodiazepines will stay in your body for some time after the effects have worn off. Combining benzodiazepines and GHB/GBL is very dangerous and can be fatal - even when taken several hours apart.

Opioids

Combining opioid-type drugs like heroin, methadone and buprenorphine with benzodiazepines is causing an increasing number of overdose deaths.

Both drugs sedate users and suppress breathing, in addition to impairing cognitive functions.

When combined, smaller amounts of each drug are needed to cause an overdose.

ADDICTION & WITHDRAWAL

Addiction

Benzodiazepines are normally only prescribed for a short length of time. (Lower doses may be prescribed for extended periods - depending on individual circumstances). 

Tolerance can build up quickly, and users can end up increasing the amount they use to maintain the initial effects. 

Using benzodiazepines for too long can cause psychological and physical addiction. 

Cutting down or stopping suddenly can cause unpleasant and dangerous withdrawal symptoms.

Reducing benzodiazepine use should only be done over a period of time, with the support of a health professional.

Withdrawal symptoms

Symptoms can start anything from eight hours to two days after you last took them. 

Symptoms can include:

• feeling sick or vomiting
• unpleasant sensations in your body, including muscle spasms, ‘crawling’ skin or goosebumps
• hallucinations (seeing or hearing things that aren’t there)
• feeling spaced out
• anxiety and panic attacks
• seizures (fits)

Call NHS 111 or go to NHS 111 online if you stop taking benzodiazepines and start to get any of these symptoms.

OVERDOSE ADVICE

If you are with someone when taking drugs, watch them carefully for the signs of an overdose.

Signs of overdose may include:

•  unconsciousness (won’t wake up with a shake or a shout)
• nausea and vomiting
• noisy, rasping, slow breathing
• difficulty breathing
• slow or erratic pulse (heartbeat)
• pale tinge to lips
• cold clammy skin
   

Benzodiazepines and opiates

If you have access to naloxone and you think someone has also used heroin, methadone or other opiates, give them a shot of naloxone.

It will not reverse a benzodiazepine-only overdose, but it will not harm them if you administer it when it’s not needed.

IF SOMEONE OVERDOSES, CALL 999 IMMEDIATELY FOR AN AMBULANCE.

Put the person in the recovery position and monitor the airway, breathing and pulse.

Do not assume that a person who seems to be coming around will not worsen later – stay with them until the ambulance arrives.

REDUCING THE RISKS FROM USING BENZODIAZEPINES

The only way to avoid the risks associated with benzodiazepines is not to use them. but if you intend to, this information will help reduce some of the risks.

Avoid buying benzodiazepines online. - usually advertised as diazepam (referred to as Valium), temazepam, and alprazolam (referred to as ‘Xanax’). 

Markings can include ‘DAN 5620’ (on one side) and ‘10’ (on the other), ‘T-20’, ‘TEM 20’, ‘Bensedin’ and ‘MSJ’, and can contain dangerously potent benzodiazepines or other dangerous substances not for medical use. 

If you use Benzodiazepines or other drugs, be extra cautious; test the strength by starting with a small test dose (1/2 a pill) and waiting at least an hour before taking more.

Don’t drive or operate machinery while using benzodiazepines or any other drugs.

Don’t mix benzodiazepines with alcohol.

Don’t mix benzodiazepines with any combination of alcohol, heroin, and gabapentinoids like gabapentin and pregabalin. Gabapentinoids work in a similar way to benzodiazepines and reduce tolerance to heroin and other opiates, increasing the chances of overdose.

If you’re going to use any drugs, make sure someone is around when you take them - if you overdose alone, nobody can help you.

If your drug use is causing you problems, you should seek help from your GP or local drug and alcohol service.

THE LAW

If you have a prescription for benzodiazepines and have obtained them from a pharmacist, you have nothing to worry about.

If you have bought them from the internet, been given them, or sold them by another person, they become a Class C drug and they are unlawful to use or possess.

Possession

Unlawful possession of Class C drugs is an offence which carries a maximum sentence of 2 years’ imprisonment or a fine, or both. 

Supplying

It is also an offence to supply or produce Class C drugs. Supply carries a maximum sentence of 14 years’ imprisonment or a fine, or both.

HELP AND SUPPORT

Here are some websites and organisations that can provide further information about benzodiazepines.

NHS

Advice, tips and tools to help you make the best choices about your health and wellbeing.

www.nhs.uk

Talk to Frank

National drugs awareness website. 24hrs a day, seven days a week.

Call 0800 77 66 00 (calls are free and confidential)

www.talktofrank.com 

Release | Drugs, The Law

Free non-judgemental, specialist advice and information on issues related to drug use and to drug laws.

www.release.org.uk