Benzodiazepines
Also known As:
Benzos, anti-anxiety medications (for all Benzodiazepines); xannies, bars, z-bars, zanbars or xanbars (for Xanax).
What is it?
Benzodiazepines are anxiolytic medications which alleviate symptoms of anxiety, including extreme fear, worry, and panic attacks. They can be used as a sleep-aid, as a muscle relaxant, to induce sedation for surgery and other medical procedures, and in the treatment of seizures and alcohol withdrawal. Benzodiazepines are also called minor tranquillizers, sedatives or hypnotics. They are the most widely prescribed psychoactive drugs in the world. Benzodiazepines can be addictive, so are typically only recommended for short term use (CAMH, 2012).
Benzodiazepines include:
Clonazepam (Rivotril), alprazolam (Xanax), lorazepam (Ativan), bromazepam (Lectopam), oxazepam (Serax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), temazepam (Restoril), triazolam (Halcion), and flurazepam (Dalmane).
How does it work?
Benzodiazepines work by depressing the nerve cells within your central nervous system. They primarily stimulate the release of the neurotransmitter GABA (gamma-aminobutyric acid) which reduces activity of nerves in the brain, producing a calming sensation and drowsiness, especially when there is excessive neuronal activity (such as when someone is experiencing a panic attack or seizure).
What does it look like?
The drug is primarily produced by pharmaceutical companies or has been “pressed” by an individual who owns a pill press, essentially creating their own pills. If they are pharmaceutical grade benzodiazepines, they primarily come in pill forms or in “bars”, which are rectangular pills that can be split for spacing out doses. The colour of the pills usually denotes what dosage they are (ex. pink for 0.5mg, white for 10mg, etc.).
Because of the drugs primary purpose of being able to sedate someone who needs immediate relief (for a panic attack or seizure) the drugs are sublingual and dissolve upon contact with saliva. If they are chewed, the taste/texture could be compared to chalk.
Is there a safe dose?
Appropriate dosage is dependent on the user, and their tolerance. The range in doses for various benzodiazepines (such as Xanax, Valium, etc.) are as low as 0.5mg and can go as high as 30mg per pill/bar. Tolerance for these drugs builds quite rapidly as compared to other psychoactive substances, so a dose/safe dose for a novel user can be substantially smaller than that of a more experienced user.
Note that if your benzodiazepine are from the illicit market, there is likely no safe dose because you do not know the contents or potency of the drug. Often, “street” benzodiazepines are cut with other substances and re-pressed into a pill, and may contain dangerously potent drugs such as fentanyl.
Effects
Benzodiazepines cause sedation in those who consume the drug, which can diminish feelings of anxiety in social situations and increase sociability - providing feelings of calmness, euphoria, lower inhibitions, and relief from insomnia or restlessness.
Side effects and cautions
The side-effects of benzodiazepines are generally mild and may not be noticed when these drugs are used at low doses.
Common side-effects include:
drowsiness
sedation
dizziness
loss of balance.
At higher doses, side-effects can include:
confusion
disorientation
amnesia
breathing difficulties
depression.
Other possible effects, which are extremely rare, include agitation, hallucinations and nightmares. Reducing the dose can help to reduce side-effects.
Benzodiazepines can make it harder to learn and remember new information and to do certain physical and mental tasks. These abilities return to normal once the effect of the drug wears off.
When used to help you get to sleep, benzodiazepines can have some “hangover” effects, such as morning and daytime drowsiness.
Addiction
When used on occasion or daily for a few weeks, benzodiazepines have a low risk of addiction. This risk increases, however, when benzodiazepines are taken regularly for more than a few weeks, especially when they are taken in higher than normal doses.
Signs of addiction include strong cravings for the effects of the drug, taking more of the drug than intended and continuing to use the drug despite the problems it may cause. Addiction may develop with or without physical dependence.
Physical dependence: When benzodiazepines are taken regularly over a long period of time, the body adapts to the presence of the drug. Signs of physical dependence include tolerance and withdrawal.
Tolerance: People are said to have developed tolerance to a drug when the same dose, taken over time, no longer has the desired effect. People may take more of the drug to achieve the same effect.
Withdrawal: Withdrawal symptoms of benzodiazepines may be similar to the reasons why the drugs were prescribed in the first place. The severity of withdrawal symptoms depends on the type of benzodiazepine used, the amount used and length of time it is used, and on whether the drug is stopped abruptly. Symptoms can include headache, insomnia, anxiety, tension, sweating, difficulty concentrating, tremor, sensory disturbances, fatigue, stomach upset and loss of appetite. Severe withdrawal symptoms from regular use of benzodiazepines in high doses may include agitation, paranoia, delirium and seizures. Withdrawal symptoms generally begin within a few days after treatment is stopped, and they may continue for two to four weeks or longer.
(CAMH, 2012)
Therapeutic Uses?
These drugs are produced pharmaceutically for the purpose of managing anxiety. However, they are typically not the first line of treatment because of their addictive properties. They are also used for individuals who experience seizures/convulsions and to aid in diminishing the withdrawal symptoms from alcohol and opioids.
Harm Reduction Tips
Start slow, you can always take more if a dose is too low for the desired effects.
Don’t mix this drug with other drugs that slow down your heart or respiratory systems (such as alcohol, GHB, opioids) because the synergistic effects of both drugs could cause the user to become unconscious and stop breathing.
If you are trying to quit or cut down using this drug, taper very slowly. Cut your doses down over an extended period of time to avoid severe withdrawal (which can cause agitation, delirium, seizures/convulsions, and extreme anxiety).
Use other methods to relax instead
The calming effects of benzodiazepines can often be achieved without drugs.
Various kinds of exercise, such as walking, running, yoga or tai chi can help, as can reducing the stress in your life and taking time for relaxing activities such as meditation, reading a book or having a warm bath. Talking with a trusted friend, family member or therapist and working out the problems that are troubling you can also help. Whenever possible, these approaches should be tried first, before benzodiazepines (CAMH, 2012).
Legal Status: Use, Possession, & Distribution
Benzodiazepines are classified in the “Controlled Drugs and Substance Act” as Schedule IV, meaning it is not illegal to possess the drug if you have a prescription for the drug. It also is not an indictable offense if you possess this drug without a prescription as long as it is for personal consumption (Government of Canada, 2019).
References
Centre for Addiction and Mental Health (CAMH). (2012). Anti-anxiety Medications (Benzodiazepines). Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/anti-anxiety-medications-benzodiazepines
Government of Canada. (2019). Controlled Drugs and Substances Act. Retrieved from https://laws-lois.justice.gc.ca/eng/acts/C-38.8/