Benzodiazepines (benzos, diazepam, valium)

Benzodiazepines are a group of pharmaceutical drugs.

There are many drugs in this group and some, such as diazepam and valium, are prescribed as medicines in the UK.

They are generally prescribed for anxiety or occasionally sleeping problems.

Other benzodiazepines are not licensed or generally prescribed in the UK, such as alprazolam (Xanax) and etizolam, but are prescribed in other countries.

The illegal market

Benzodiazepines of all kinds are available in the illegal drugs market.

Some may be diverted from prescription but the majority are purchased as illegal drugs and are generally referred to as street valium which can contain a range of unlicensed medicines and counterfeit drugs.

It’s common to see etizolam as the active ingredient in Scotland and the wider UK.

More information about street valium is available at the Welsh Emerging Drug Identification Service (WEDINOS)

Risks of using benzodiazepines

Using benzodiazepines with alcohol and other depressants like heroin increases their effects and can increase toxicity.

They slow down the central nervous system, increasing the risk of overdose.

Longer term effects can include lasting cognitive impairment, return of insomnia, anxiety and depressive symptoms often referred to as rebound symptoms.

Dependence

People become dependent on benzodiazepines if they take them for more than 4 weeks

If a person takes a benzodiazepine regularly, they will get the full effect of the drug for the first few weeks. As their body becomes used to benzodiazepines the effect diminishes.

There is a risk of both psychological and physical dependence with repeated use.

People can experience withdrawal effects which can be life threatening if they try and stop suddenly.

How to stop

If someone is taking benzodiazepines regularly for more than 4 weeks, it could be fatal to stop taking them.

It’s important to seek medical advice either through your GP or local community addiction team if you have been using them over a long period and want to stop.

If you have been using for a shorter period, it can greatly reduce any unpleasant milder withdrawal effects by reducing gradually over a few days.

More advice on benzodiazepine withdrawal is available from We Are With You.

How to reduce your risk

If you decide to use benzodiazepines, start low and go slow.

Tablet strengths vary dramatically and some take a while to have an effect. Try a small test amount, such as half a tablet, and wait at least 2 hours before taking any more.

Avoid mixing benzodiazepines with alcohol, prescription drugs and other drugs - especially other depressants/downers such as alcohol, gabapentin and opioids (heroin, methadone).

All of these drugs can depress breathing resulting in a serious risk of death if mixed.

Other side effects

Benzodiazepines can increase the risk of drowsiness, problems with movement, balance and speech and disturbances of consciousness if taken with some prescribed and over the counter drugs

These include:

• neuroleptics
• antidepressants
• antihistamines
• analgesics
• antiepileptics and similar prescribed medications

Staying safer

Control how much you take in one session and don’t take all the tablets you have at once. Put some away in a safe place if you have a large amount.

If going to sleep, ensure you sleep on your side to avoid choking

Tolerance and dependency can develop quickly and if you have recently started using, try not to use every day and take breaks in between

Avoid taking other drugs or more benzodiazepines to deal with withdrawal symptoms

When to get help

Seek help from medical support quickly if you experience any negative side effects

These include overdose symptoms such as:

• blue lips
• loss of consciousness
• noisy, rasping, slow breathing
• withdrawal effects like fitting or seizures
• extreme mental confusion
• hallucinations

If you suspect that someone has possibly taken opioids (heroin or methadone) in addition to benzodiazepines then administer naloxone if it is available.

Naloxone will not reverse a benzodiazepine-only overdose but it will do no harm if you administer it when it’s not needed.