Benzodiazepines

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Benzodiazepines are a group of tranquilliser drugs, with sedative (calming) effects.

Other names

benzos, vallies, blues, diazepam, downers

Appearance

Commonly found as blue, white or yellow round pills. They can also be pressed into ovals, diamonds or other multi-sided shapes. Occasionally they are sold as a powder, or as a gel capsule filled with powder. They can also be dissolved and infused onto substances such as paper (blotters) and gelatine (gel tabs).

Drugs Wheel Category

Depressants

Legality

Misuse of Drugs Act (1971) - Class C.

The Misuse of Drugs Regulations (2001) control the administration, prescribing, dispensing, record keeping and disposal of licensed medicinal benzodiazepines. In the UK, many 'non-medicinal' benzodiazepines are controlled by the Misuse of Drugs Act (1971) as Class C drugs. Many newer benzodiazepines are not controlled by the Misuse of Drugs Act. Their supply is controlled by the Psychoactive Substances Act (2016), which bans the sale of substances capable of producing a psychoactive effect. Possession is not an offence (unless in a custodial institution such as a prison).

Penalties for possession without a prescription are up to 2 years in prison and/or an unlimited fine. Penalties for supply are up to 14 years in prison and/or an unlimited fine.

How it’s taken

The most common route of administration for benzodiazepines is swallowing. They can also be absorbed in the mouth by placing them underneath the tongue (sublingual administration) or between the gums and cheek (buccal administration). They are less commonly snorted.

Dose

Variation in the contents of fake and street benzos makes accurate dosing difficult. Each different type of benzo also has a different potency (the amount required to produce an effect) so the dose for an average person will depend on several factors, including the type of benzodiazepine.

Some benzodiazepines can stay in your body for a few days, sometimes weeks, after use so the drug may be active long after the effects have worn off. The half-life of a drug is the time taken for your body to metabolise (breakdown and remove) half of the drug.

For example, the half-life of diazepam is at least 20 hours. This means if you take a 10
milligram (mg) diazepam pill, you will have at least half of it (5mg) in your body 20 hours later. If you were to take another 10mg diazepam pill 20 hours after the first, then you will have at least 15mg (5mg from day 1 + 10mg from day 2) in your body, not 10.

If benzodiazepines are taken regularly, they will accumulate and you may have more in your body than expected, which increases the risk of overdose. Regular dosing will also increase your tolerance to the drug.

The information below was taken from tripsit.me (accessed Oct 2020)

Benzodiazepine: dose equivalent of 10mg diazepam (oral)

Alprazolam (Xanax): 0.5mg

Diazepam (Valium): 10mg

Diclazepam (Ro5-3448): 1mg

Etizolam (Etizola): 1mg

Flubromazolam: 0.25mg

Phenzepam: ~1mg

Pyrazolam: 0.83mg

Temazepam (Restoril): 20mg

General information on dosing.

Effects

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The overall effect depends on the setting, the person and the drug. Although benzos work in a similar way, each benzo has its unique dose, duration and effects – some have a stronger sedative effect and others have a stronger relaxant effect.

Benzodiazepines can cause drowsiness and long periods of sleep. They are central nervous system depressants and can slow down your heart rate and breathing. People may experience a ‘floating’ sensation and feel warm, calm, relaxed and tired.

Benzodiazepines can temporarily reduce feelings of anxiety; however, some people may experience an increase in anxiety, particularly at higher doses. High and/or frequent doses also increase the risk of seizures or ‘fitting’, aggression and emotional turbulence.

Other effects can include lack of coordination, dizziness, slowed or slurred speech, reduced mental alertness, short-term memory loss and blackouts (not being able to remember things that happened when you were under the influence). They can also impair judgement of danger which can result in risky behaviour.

Benzodiazepines can be split into three main types:

PHARMACEUTICAL

Pharmaceutical benzodiazepines are medicines that will appear in blister packs or medication bottles alongside instructions about dose and side effects. These drugs are manufactured under controlled conditions, which assures that the dose and compound listed on the packaging is accurate. Pharmaceutical benzodiazepines may be referred to by their chemical name or their brand name, for example diazepam is prescribed under the brand name Valium.
Traditionally, illicit benzodiazepines were diverted from the pharmaceutical market (i.e. medicines  stolen from the place of manufacture or passed from someone who has a prescription for it).

FAKE

Fake benzos are counterfeit drugs that are made to look like genuine medicines. In Scotland, many fake benzos are designed to look like diazepam (Valium), alprazolam (Xanax) or temazepam (Restoril).

Legitimate looking packaging (including boxes, information sheets and blister packs) is not confirmation of the contents and they can contain no active ingredients, or different active ingredients and concentrations than stated. Fake pills can sometimes look to be of poorer quality than genuine pharmaceuticals but it’s not always easy or possible to tell. Signs of fake medicines can include unsealed boxes, spelling mistakes and missing licensing/pharmacy information, as well as physical defects such as pills that are uncoated, poorly pressed, discoloured, chipped, broken, powdery.

STREET

In recent years, a number of new psychoactive substances (NPS) that are benzodiazepines have emerged. These are drugs that have been newly developed or developed years ago but have recently resurfaced. Some are prescribed as medicines in other countries but are not licensed for use in the UK. In Scotland, many street benzos contain an NPS benzodiazepine, like etizolam, rather than historically familiar drugs like diazepam.

They are generally pressed into pills and sold loose in bags. They may be mis-sold as diazepam but they are often referred to using generic, interchangeable terms such as vallies, blues and street benzos. Some people may refer to the benzos by using the information stamped on the pills, examples include ‘Roche 10’, ‘MSJ’, ‘T20’, ‘WW’ and ‘D10’.

Risks

  • Use can lead to memory loss
  • Tolerance develops quickly which can lead to people using more over time, increasing the risk of dependence and overdose
  • Withdrawal symptoms can happen after even short periods of time
  • Increased risk of overdose if mixed with alcohol, opiates (like heroin) or opioids (like methadone) or other depressant drugs

Harm reduction

If you choose to take benzodiazepines then the following steps can help to reduce harm.
  • Downers include opioids (like heroin) and depressants (such as benzos and alcohol). These types of drugs depress the central nervous system which means they slow down heart rate and breathing. Mixing benzodiazepines with other downers, including other benzodiazepines, is extremely dangerous and increases the risk of respiratory depression and death.
  • Naloxone will not reverse a benzodiazepine only overdose. If you suspect that someone has taken opiates then administer naloxone.
  • Mixing benzos with uppers (such as cocaine, caffeine and amphetamine as well as ‘smart’ or ‘study’ drugs like modafinil or Adderall) is risky and increases the strain on the heart and body and can cause feelings of anxiety. Mixing can also reduce some of the desired effects of both drugs, whilst increasing toxicity.
  • Ketamine is a dissociative drug with depressant effects. Mixing benzos with ketamine is risky as it may lead to blackouts and unconsciousness.
  • Drugs that have a psychedelic effect (such as magic mushrooms and LSD) can lead to overwhelming or difficult experiences. If someone is having a difficult experience, avoid giving them benzodiazepines to stop the trip, as they may not be able to accurately explain to you the other drugs that they have taken that day and therefore adding another drug to the mix may be dangerous. Instead try to stay calm, reassure the person and help them to move somewhere quiet and comfortable. Get help if you need it.
  • Call 999 and ask for an ambulance if you see the signs of an overdose: confusion, unconsciousness (won’t wake with a shout or a shake), severe nausea and vomiting, fitting, difficulty breathing, snoring/raspy breathing, blue/pale tingeing of knees, hands and lips, slow or erratic pulse (heartbeat), pale, cold and clammy skin.
  • Avoid taking benzos alone and stay with friends in case you experience negative effects.
  • Try to sleep on your side if you have been taking benzos. This will help to keep your airway clear.
  • Unlike pharmaceuticals fake/street benzos are often manufactured in unhygienic environments with little quality control or assurance. This makes variation between pills more likely and it is common for fake/street benzos to vary widely in ingredients and strength. The active ingredient can be spread unevenly throughout a batch of pills. This means some pills contain no psychoactive substance whereas others, that look the same and are from the same batch, contain much more than expected. Dose low and go slow! Start with a small test dose and wait at least 2 hours before re-dosing.
  • Tolerance to benzodiazepines develops quickly. Tolerance to a drug means that a higher dose of the drug is needed to achieve the desired effect, which increases the risk of overdose and dependency.
  • Sudden benzo withdrawal (or withdrawal from other depressant drugs like alcohol and GHB) is risky and can be life threatening. It is important to slowly and steadily reduce the quantity of benzos over time, rather than suddenly stopping. This is called tapering and your GP or local drug service can help with this.
  • The longer you have been taking them without a break, the greater the risks are around stopping. The length of time it takes to taper will depend on the quantity and length of time the benzos were taken for. The Ashton Manual provides a detailed guide on low risk tapering from benzo use.
  • Withdrawal symptoms can happen even after short periods of use. Avoid taking every day and take regular breaks from use.
  • Avoid taking other drugs or more benzodiazepines to deal with withdrawal symptoms.
  • If symptoms become distressing seek medical help and in an emergency call 999.
  • Be aware that once you stop taking a drug your tolerance to it will reduce. If you choose to take it when your tolerance is reduced it will take a smaller amount to get the intended effect and you are at a greater risk of overdose.
  • Benzos impair reaction times. Avoid driving or using heavy machinery whilst under the influence.
  • Remember that taking a benzodiazepine won’t simply cancel out the effects of stimulants or other drugs – it may make their effects more unpleasant.
  • The short-lasting effect of some benzos can encourage people to take it frequently or take more than they need. Be aware that although you may not feel the effects, the drug is still present in your body so avoid re-dosing too frequently to avoid overdose and death.

SWALLOWING

  • Dose low. One pill may contain more than one dose and even if the pill looks the same and was part of the same batch, the amount of the drug between pills can vary. If you are not 100% sure of the ingredients, start with half a pill.
  • Some pills can be hard to break. For best effect use a pill cutter and break your pills up well in advance of when you plan to take them (while you are still sober if possible).
  • Wait at least two hours before re-dosing. Some pills will take a while to break down and therefore longer for you to feel the effects.
  • Swallow them with water or an isotonic drink. Be aware that if you crush, chew or split a pill, or consume pills that are uncoated (no shiny, film or sugar coating), the effects may come on more quickly and intensely. Pills with a strong colour (usually blue or yellow) can stain the tongue, teeth and lips for several hours after use.

SNORTING

Snorting is a less common way to take benzodiazepines. It is not recommended as benzodiazepine tablets contain colouring, bulking agents and binding agents (ingredients added to help form the pill) and over time these ingredients can degrade the septum (the cartilage separating the nostrils). Snorting crushed pills can also lead to a reduced sense of smell, nosebleeds, pain when swallowing, a runny/blocked nose and recurring nose, sinus or throat infections.

  • If snorting benzodiazepine powder, be aware that many benzodiazepines are active in very small doses (for example, one gram of etizolam powder can produce 1000 doses). Extensively research the substance and always start with a tiny dose for that specific drug.
  • Grind it down as fine as possible and divide into small lines. Ensure the surface is clean – unclean surfaces such as toilets, phones and keys can spread disease. Use an alcohol wipe if possible.
  • Avoid using bank notes as a tool to snort benzos, as they aren’t disposable and can cut
    the inside of your nose – post-its or paper straws are a good alternative to notes.
  • Sharing snorting tubes can spread infections and blood borne viruses (e.g. hepatitis C, HIV)
    – only use your own equipment. Get tested regularly for BBVs.
  • Position the tube as high up the nostril as possible and alternate nostrils for each dose.
  • The effects come on more quickly when snorted than when swallowed. If the effects come on too intense, stay calm, move somewhere quiet and cool and sip water.
  • Rinse your nose out with clean water at the end of a session, to prevent the powder causing further damage to the inside of your nose.
  • Apply a thin layer of vitamin E oil to the inside of the nose after rinsing.

Detection time

People taking benzodiazepines have reported the following detection time, but this cannot be taken as a recommendation; detection of any drug will depend on purity, regularity of use, other medications or drugs you have taken, your body and how it’s taken.
  • Diazepam can be detected for 2-28 days in urine and potentially up to 6 weeks with regular, heavier use.