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Benzodiazepines

 

What are Benzodiazepines?

This group of drugs are also known as tranquillisers and sedatives. The best known are probably diazepam (brand name Valium) and nitrazepam (Mogadon). Benzodiazepines basically fall into two groups – the anxiolytics (for treating anxiety) and the hypnotics (for treating insomnia). Benzodiazepines are useful drugs for treating a number of conditions but, because of their Side effects and the risk of dependency (see below), they are not suitable as routine ‘sleeping tablets’, nor are they an effective treatment for depression.

How do benzodiazepines work?

Benzodiazepines work by depressing the part of the brain, called the reticular activating system, that regulates how active the brain is. They do this by increasing the action of a substance called gamma-aminobutyric acid (GABA), a chemical involved in slowing down the transmission of nerve signals in the brain.

What are they for?

While all benzodiazepines essentially have the same action in the brain, some calm its activity to a greater extent, making certain drugs more suitable for treating anxiety and others for treating insomnia. Benzodiazepines are also used in anaesthesia, and for treating epilepsy and muscle spasms. They may also be prescribed for people who are experiencing an episode of mania – a mental disorder that involves excessive activity and long periods without sleep.

Drugs include:

Drug name

Street name

Main use

Therapeutic dose range

Diazepam Vallies Anxiety 5-20mg
Lorazepam Anxiety 1-4mg
Flurazepam Insomnia 15-30mg
Nitrazepam Moggies Insomnia 5-10mg
Temazepam Rugby Balls Insomnia 10-20mg
Flunitrazepam Roofies Insomnia 0.5-1mg
Street use Benzodiazepines are swallowed in large numbers or can be injected by crushing tablets or injecting jelly from capsules. Dose levels vary but daily doses of 20 times the normal therapeutic range have been reported. Benzodiazepines are often mixed with other drugs. In Scotland, for example, a recent trend has been the use of temgesic (an opiate) and temazepam (a benzodiazepine) in combination.
Drug effect Benzodiazepines are depressants or “downers”. They act on the part of the brain associated with anxiety, reduce tension and induce sleep. Even at low doses, benzodiazepines can affect mental and physical functioning, but less so than alcohol. At higher doses, they produce “drunken” and sometimes aggressive behaviour.
Surprisingly, mixing benzodiazepines with other “downers” such as barbiturates, alcohol or opiates produces a stimulant effect which increases alertness and confidence.
Dependence At low doses within the therapeutic range, tolerance does not develop to any great extent and only small increases in doses are reported over time. But among street users who are using large amounts, tolerance to the sedative effects (but not to the calming effects) develops rapidly and doses escalate.
Dependence can also develop quickly and some people report withdrawal symptoms after only four weeks’ use at therapeutic (low) doses. People vary in the severity of symptoms they experience. Among long-term and heavy users, panic attacks, feelings of unreality, distortion of perception, sweating, restlessness and tremor are common.
Sudden withdrawal from benzodiazepines is dangerous as seizures can occur. Therefore withdrawal from the drug should be gradual and conducted under medical supervision. Withdrawal from benzodiazepines can be distressing because symptoms often last for many months.
Long-term use The effects of long-term use of benzodiazepines include mental confusion, memory loss, depression, aggressive behaviour and loss of physical coordination.
Injecting with dirty or used needles can cause serious infections like hepatitis B, blood poisoning and HIV infection. Injecting crushed tablets or jelly (from green capsules) can cause serious circulation problems and in some cases, loss of limbs.
Overdose risk Death from overdose is rare with this group of drugs because large doses are needed but the risk increases if benzodiazepines are mixed with other “downers” like opiates, barbiturates or alcohol.
Risk in pregnancy Babies born to mothers who continue to take benzodiazepines during pregnancy may have withdrawal symptoms which include tremor, irritability, hyperactivity and frantic sucking. Withdrawal symptoms may be more severe than expected from the mother’s dose, as the drugs build up in the baby over time.
Withdrawal from benzodiazepines should be gradual over a few weeks.
Legal status Benzodiazepines are prescription-only medicines and class C controlled drugs (Schedule 4), except temazepam, which was moved to Schedule 3 on 15 January 1996. This means they can be possessed in medicinal form without a prescription but it is an offence to supply them to others. All benzodiazepines carry the same penalties, as listed below.
Maximum penalty for possession
If not in medicinal form
Two years and/or unlimited fine
Maximum penalty for supply Five years and/or unlimited fine

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Diazepam

 

Street name Vallies
Brand name Valium (Roche)
Drug effect Depressant or “downer”
Description Tablets (2mg, 5mg, 10mg)
Oral solution (2mg/5ml)
Injection
Therapeutic use Anxiety, acute alcohol and opiate withdrawal, insomnia
Method of use Injected or swallowed
Dependency Yes
Withdrawal Effects of drug last for up to 24 hours and withdrawal symptoms begin up to seven days after last dose. Symptoms include anxiety, restlessness, tremor, feelings of unreality, distortion of perception. Symptoms may last for many months. There is a risk of seizures following sudden withdrawal.
Long-term use Mental confusion; memory loss; depression; unpredictable or aggressive behaviour; loss of physical coordination.
If injected:
  • infection risk
  • circulatory problems.
Overdose risk Death from overdose is rare but risks increase if diazepam is mixed with other “downers” like opiates, barbiturates or alcohol.
Legal status Diazepam is a prescription-only medicine and a class C controlled drug (Schedule 4). It may be possessed in its medicinal form without a prescription but it is an offence to supply it to others.
Special note The number of prescriptions for diazepam dispensed in Northern Ireland between January and December 2000 was 434,139.

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Lorazepam

 

Street name N/A
Brand name Ativan (Wyeth)
Drug effect Depressant or “downer”
Description Tablet (1mg, 2.5mg)
Injection (4mg/ml)
Therapeutic use Moderate to severe anxiety
Method of use Injected or swallowed
Dependency Yes
Withdrawal Effects of lorazepam last for six to 10 hours and withdrawal symptoms begin up to three days after last dose. Symptoms may be particularly severe with this drug and include anxiety, restlessness, tremor, feelings of unreality and distortion of perception.
There is a risk of seizure following sudden withdrawal.
Long-term use Mental confusion; memory loss; unpredictable or aggressive behaviour; loss of physical coordination.
If injected:
  • infection risk
  • circulatory problems
Overdose risk Death from overdose is rare. Risks increase if lorazepam is mixed with other “downers” like opiates, barbiturates or alcohol.
Legal status Lorazepam is a prescription-only medicine and a class C controlled drug (Schedule 4). It may be possessed in medicinal form without a prescription but it is an offence to supply it to others.
Special note Withdrawal from lorazepam can be dangerous because of seizure risk. Gradual withdrawal under medical supervision is recommended.

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Nitrazepam

 

Street name Moggies
Brand name Mogadon (Roche), Nitrados (Berk), Remnos (DDSA), Unisomnia (Unigreg).
Drug effect Depressant or “downer”
Description Tablet (5mg)
Oral suspension (2.5mg/5ml)
Therapeutic use Insomnia
Method of use Injected or swallowed
Dependency Yes
Withdrawal Effects of nitrazepam last for up to 24 hours and withdrawal symptoms begin up to seven days after last dose. Symptoms may last for months and include anxiety, restlessness, tremor, feelings of unreality, distortion of perception.
There is a risk of seizure following sudden withdrawal.
Long-term use Mental confusion; memory loss; depression; unpredictable or aggressive behaviour; loss of physical coordination.
If injected:
  • infection risk
  • circulatory problems.
Overdose risk Death from overdose is rare but risks increase if nitrazepam is mixed with other “downers” like opiates, barbiturates or alcohol.
Legal status Nitrazepam is a prescription-only medicine and a class C controlled drug (Schedule 4). It may be possessed in medicinal form without a prescription but it is an offence to supply it to others.
Special note Withdrawal from nitrazepam can be dangerous because of seizure risk. Gradual withdrawal under medical supervision is recommended.

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Temazepam

 

Street name Rugby balls, tems, jellies
Brand name Normison (Wyeth), Euhypnos
Drug effect Depressant or “downer”
Description Yellow capsules (10-20mg); oral solution (10mg/5ml elixir); green soft gelatin capsules (2-20mg); white scored tablets (10mg and 20mg); “Gelthix” capsules (10-30mg)
Therapeutic use Insomnia
Method of use Injected or swallowed
Dependency Yes
Withdrawal Effects of temazepam last for six to 10 hours and withdrawal symptoms begin within three days of last dose. Symptoms may last for months and include anxiety, restlessness, tremor, feelings of unreality and distortion of perception. There is a risk of seizure among heavy users following sudden withdrawal.
Long-term use Mental confusion; memory loss; depression; unpredictable or aggressive behaviour; loss of physical coordination.
If injected, there is risk of infection and circulatory problems (including serious injury to veins).
Overdose risk Death from overdose is rare but risks increase if temazepam is mixed with other “downers” like opiates, barbiturates or alcohol.
Legal status Temazepam is a prescription-only medicine and a class C controlled drug (Schedule 3). It is an offence to possess it without a prescription or other authority. It is also an offence to supply or to intend to supply it to others.
Special note Withdrawal from temazepam can be dangerous because of seizure risk. Gradual withdrawal under medical supervision is recommended.

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Flunitrazepam

 

Street name Roofies, rophies, ropies, ruffies, roche, roachies, R-2, mexican valium, rope, rib, la roche and forget-me-pill.
Brand name Rohypnol (Roche).
Drug effect Sedation and amnesia
Description Tablets.
Therapeutic use Short-term treatment of insomnia when severe. Also used for the induction of sleep at unusual times.
Method of use Swallowed, injected.
Dependency Yes
Withdrawal Effects of flunitrazepam can last for up to 24 hours. Tolerance develops within three to 14 days of continuous use. Withdrawal may precipitate symptoms including anxiety, restlessness, tremor, feelings of unreality, distortion of perception and sleep disruption.
Long-term use Mental confusion; memory loss; depression; unpredictable or aggressive behaviour; loss of physical coordination; headache; changes in vision.
If injected:
  • infection risk
  • circulatory problems.
Overdose risk Flunitrazepam is one of the most toxic of benzodiazepines. Its effects are increased by alcohol and other drugs affecting the central nervous system. Breathing difficulties can occur. Deaths have been reported.
Legal status Flunitrazepam is not registered as a controlled drug. It is a prescription-only medicine (Schedule 3).
Special note  Flunitrazepam has a reputation as a date rape drug and as a party/club drug, because of its quick onset of sedation, amnesic effects and additive effects with alcohol.
Although this association has not been conclusively proven, the manufacturers reformulated the tablets sold on the UK market in 1998 to make misuse more difficult. The new tablet takes 20 minutes to dissolve in liquids and releases a deep blue dye. It also floats to the surface and makes drinks appear cloudy and frothy as it begins to dissolve, so should be detectable even in strongly coloured drinks. Any sedative or depressant drug may have similar effects to Rohypnol, especially if mixed with alcohol.

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