minor tranquillisers

Benzodiazepines (sometimes called ‘benzos’) are also referred to as ‘minor tranquillisers’. They work by slowing down the activity of the central nervous system. They slow the messages going to and from the brain to the body, including physical, mental and emotional responses. Like alcohol, cannabis and heroin, they are depressants. Benzodiazepines (pronounced BEN-ZO-DYE-AS-E-PEENS) are produced through a process of chemical synthesis. The benzodiazepine group contains more than twenty-four specific drugs. Each of these has a chemical or ‘generic’ name, and each drug is sold under one or more brand names. They are most often prescribed in tablet or capsule form. They come in a variety of colours and shapes. Whether taken orally or intravenously, the drug is absorbed into the bloodstream and circulates through the body.

What are they used for?

Medical uses

Medically, benzodiazepines are classified as sedatives/hypnotics (to induce sleep) or anxiolytics (to relieve anxiety). In practice, they perform all of these functions, although different ones are prescribed based on how quickly they work and how long they last. Some benzodiazepines are prescribed by doctors to relieve stress and anxiety and to help people sleep. They are also used to treat epilepsy (sometimes), to relax muscles, to help people withdraw from alcohol, or as an anaesthetic before surgery.

Non-medical uses

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

Effects of benzodiazepines

The effects of any drug (including benzodiazepines) vary from person to person, according to:

• age
• general health
• if other drugs are being taken at the same time
• how much is taken and how it is taken
• whether the drug has been taken before, and for how long.

Immediate effects

Low to moderate doses

Short-term use (less than two weeks) of benzodiazepines may have the following effects:

• relaxation
• calmness
• relief from tension and anxiety.

Other effects can include drowsiness, tiredness, lethargy, dizziness, vertigo, blurred or double vision, slurred speech, stuttering, mild impairment of thought processes and memory, feelings of isolation and emotional depression.

Higher doses

The most probable effects of higher doses are:

• drowsiness
• over-sedation
• sleep.

Before the person falls asleep, or if they do not sleep, higher doses may produce an effect similar to alcohol intoxication. Effects could be confused, 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 unconsciousness or coma. Death rarely occurs from overdose of benzodiazepines alone, but some deaths have occurred when large doses were combined with alcohol or other drugs. Deaths have occurred due to the inhalation of mucus or vomit while the person has been unconscious.

The use of benzodiazepines over a long period of time (more than two to three weeks) is not recommended. Benzodiazepines can help to relieve anxiety in the short term. However, they do not solve the problem that caused the anxiety in the first place - they treat the symptoms but not the cause.

Long-term use of benzodiazepines may cause:

• drowsiness
• lack of motivation
• difficulty thinking clearly
• memory loss
• personality change
• changes in emotional responses
• anxiety
• irritability
• aggression
• difficulty sleeping
• disturbing dreams
• nausea
• headaches
• skin rash
• menstrual problems
• sexual problems
• greater appetite
• weight gain
• increased risk of accidents
• increased risk of falling over (older people).

Very high doses of benzodiazepines over a long period of time may cause confusion, lack of coordination, depression and slurred speech, and may lead to increased aggressiveness. It is ironic that the long-term effects include anxiety and sleeplessness, when these are the very problems that benzodiazepines are supposed to relieve.

Bingeing

In the case of benzodiazopines, a ‘binge’ is when a person takes a whole pack in one session, rather than on a daily basis. There is a strong possibility 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.

Injecting benzodiazepines

Benzodiazepines are intended for oral use only. Some people inject benzodiazepines to get ‘high’, or to increase the effects of other drugs. This practice is increasing, even though the effects are not very satisfying. Severe health problems can result from the injection of benzodiazepines, including:

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

Sharing needles, syringes and other injecting equipment can greatly increase the risk of contracting blood-borne viruses such as hepatitis B, hepatitis C and HIV (Human Immunodeficiency Virus - the virus that causes AIDS).

Benzodiazepines & Other Drugs

Combining benzodiazepines with alcohol, barbiturates, antihistamines, antidepressants, cannabis or heroin can greatly increase the effects of the drugs taken. This can be very dangerous, especially if the person intends to drive. Some combinations can be life threatening.

Taking benzodiazepines with alcohol greatly reduces alertness and judgement of time, space, and distance. When large amounts of alcohol and benzodiazepines are taken together, it can result in death.

Combining benzodiazepines with other sedatives, antihistamines (cough, cold and allergy remedies), barbiturates or sleeping pills increases the effects on the brain, resulting in unconsciousness and failure to breathe, which can lead to death.

The combination of heroin and benzodiazepines can be deadly. With benzodiazepines in the system, it takes less heroin to overdose.

Tolerance & Dependence

Tolerance

People who are physically dependent on benzodiazepines usually develop tolerance to the drug. That is, they need to take more and more to get the same effect. This can happen very quickly with benzodiazepines. The effectiveness of benzodiazepines used as sleeping pills can wear off after three nights.

Dependence

Dependence on benzodiazepines can be psychological or physical, or both. Dependence can occur after using them for a few months. The feelings of dependence often bear no relation to the actual 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 the benzodiazepines (or severely cuts down their dose), they will have physical withdrawal symptoms because their body has to readjust 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 a few weeks or months, or even up to one year. A small percentage of people have even longer-lasting symptoms. The symptoms are usually related to the length of time the person has taken benzodiazepines, and the type of benzodiazepines taken (whether its effects are slow or fast-acting), rather than the amount used.

Withdrawal symptoms can include:

• headaches
• sweating
• confusion
• nervousness
• tension
• anxiety and panic attacks
• dizziness
• heightening of the senses of sight, touch, hearing, smell and taste
• poor appetite
• nausea, vomiting and stomach pains
• inability to sleep properly
• depression
• feelings of isolation and unreality
• delirium and paranoia.

Withdrawal symptoms tend to come and go, but all withdrawal symptoms will eventually disappear as the body adjusts to functioning without the drug.

Gradual withdrawal

Withdrawal symptoms can be severe if these drugs are stopped suddenly, especially after high doses. Fits or seizures can occur. Medical experts advise that people who have been using benzodiazepines for more than two or three weeks should not suddenly stop taking them without consulting a doctor or health worker. Health experts usually recommend a slow reduction in dose over two or three months. This reduces the severity of the withdrawal symptoms. If you suffer from anxiety and/or insomnia, keep in mind they may simply be withdrawal symptoms. If so, these symptoms will eventually cease.

Treatment Options

There are a number of drug treatment options available in New Zealand. While abstinence may be a suitable treatment aim for some people, many programmes recognise that for others this may not be possible or realistic. Most programmes adopt strategies that have an overall aim of reducing the harms and risks related to the person’s drug use. Some treatment options include counselling, withdrawal (detoxification) and pharmacotherapy.

Ring 0800 787 797 for options.

Pregnancy & Breastfeeding

Pregnancy

Benzodiazepines taken during pregnancy cross the placental barrier and can affect the growth and development of the baby. Anyone taking a prescription of benzodiazepines should see a doctor before altering their dosage.

Benzodiazepines can produce withdrawal symptoms in newborn babies, which can last for a week or longer. Withdrawal symptoms can include breathing problems, poor body temperature control, poor muscle tone and sucking difficulties.

Breastfeeding

Benzodiazepines can be passed from mother to baby through breast milk. The baby’s body cannot process these drugs quickly, and they can accumulate in high doses. See your doctor or other health professional if you are taking or planning to take any substances while pregnant or breastfeeding, including prescribed and over-the-counter medications.

Benzodiazepines & Driving

It could be dangerous to drive after taking benzodiazepines. They make the driver drowsy, reduce concentration and coordination, and impair judgement. They can also cause dizziness and affect vision. It is even more dangerous to drive when benzodiazepines are combined with alcohol or other drugs.

It is illegal to drive while under the influence of any drug (including benzodiazepines). Breaking this law carries heavy penalties, including disqualification, fines and even imprisonment.

Benzodiazepines and social problems

In New Zealand, there is concern about the number of people using benzodiazepines for long periods of time. In the short term, benzodiazepines may help the person get through a difficult period in their life. However, when the person stops taking benzodiazepines, the problems will still be there. It is important to try and deal with those problems. There are many ways to deal with stress and anxiety without using benzodiazepines. Relaxation techniques, stress management courses, counselling, a healthy diet and plenty of exercise all help. Contact your local community health service or ring 0800 787 707 to find out alternative ways of dealing with stress and anxiety.

Tips

If you are concerned about your dosage, it is best to talk first with the prescribing doctor. Remember, there is no standard dosage suitable for everyone. If you are using benzodiazepines, consider whether you really need them. Talk to the doctor and ensure you have medical support through a gradual withdrawal programme.

If you haven’t seen your doctor for a while, make an appointment to have the medication reviewed and to discuss alternatives. Try to work out what triggers the desire to use benzodiazepines. Are there certain situations in which your desire to use them is heightened? If so, what can be done to cope with these situations or ‘triggers’? Keeping a diary of use for one week can help you identify these situations.

Legal implications

3 months imprisonment and/or $500 fine.

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 111. 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 condition
• Before using benzodiazepines, make sure you and your friends know what to do in a crisis.