Benzodiazepines

Types of benzodiazepines

There are three types of benzodiazepines: long, intermediate and short-acting. Short-acting benzodiazepines have stronger withdrawal or ‘come down’ effects and can be more addictive than long-acting ones.²

Benzodiazepines are known by their chemical (generic) name or their brand name. In each case the drug is the same – it’s just made by a different company. Some common benzodiazepines are:

Pharmaceutical names

Adapted from: Brands B, Sproule B & Marshman J. (eds) (1998) Drugs & Drug Abuse (3rd ed.) Ontario: Addiction Research Foundation.

How are they used?

Benzodiazepines are usually swallowed. Some people also inject them.

Effects of benzodiazepines

Use of any drug can have risks. It’s important to be careful when taking any type of drug.

Benzodiazepines affect everyone differently, but the effects may include:

• reduced stress
• euphoria
• reduced anxiety
• calmness
• depression
• confusion
• feelings of isolation or euphoria
• impaired thinking and memory loss
• headache
• drowsiness, sleepiness and fatigue
• dry mouth
• slurred speech or stuttering
• double or blurred vision
• impaired coordination, dizziness and tremors
• nausea and loss of appetite
• diarrhoea or constipation.¹

Injecting benzodiazepines may also cause:

• vein damage and scarring
• infection, including hepatitis B, hepatitis C, HIV and AIDS
• deep vein thrombosis and clots which can result in loss of limbs, damage to organs, stroke and possibly death.⁵

Injecting drugs repeatedly and sharing injecting equipment with other people increases the risk of experiencing these effects.⁴

Who are benzodiazepines not recommended for?

Benzodiazepines are not recommended for use during pregnancy or breastfeeding, as they are associated with pre-term delivery, low birth weight and potential birth defects.^5-7

They may also be dangerous for people with:

• acute asthma, emphysema or sleep apnoea
• advanced liver or kidney disease
• or people with a history of substance use disorders, as their use can lead to dependence.^8,9

Benzodiazepines taken by elderly people can increase their risk of falls and injury.

Overdose

Benzodiazepines are often present in patients who have intentionally or accidentally overdosed.

If you take a large amount or mix them with other drugs, you could overdose.
Call triple zero (000) and request an ambulance if you or someone else has any of the following symptoms (emergency services are there to help and can provide instructions over the phone).

Symptoms include:

• over-sedation or sleep
• jitteriness and excitability
• mood swings and aggression
• slow, shallow breathing
• unconsciousness or coma
• death (more likely when taken with another drug such as alcohol).³

Long-term effects

Regular use of benzodiazepines may cause:^3,11

• impaired thinking or memory loss
• anxiety and depression
• irritability, paranoia and aggression
• personality change
• weakness, lethargy and lack of motivation
• drowsiness, sleepiness and fatigue
• difficulty sleeping or disturbing dreams
• headaches
• nausea
• skin rashes and weight gain
• addiction
• withdrawal symptoms (see below).³

There is some evidence that long-term, heavy use of benzodiazepines is a risk factor for epilepsy, stroke and brain tumours.¹²

Using benzodiazepines with other drugs

The effects of taking benzodiazepines with other drugs − including over-the-counter or prescribed medications − can be unpredictable and dangerous.

Benzodiazepines + alcohol or opiates (such as heroin): breathing difficulties, an increased risk of overdose and death.^{6, 7}

Benzodiazepines + some pharmaceutical drugs: strong pain-relievers, antidepressants, anticonvulsants, anti-psychotics, some anti-histamines and over-the-counter medications can have an adverse effect when taken with benzodiazepines and lead to breathing difficulties, an increased risk of overdose and death.^{7, 8}

The use of benzodiazepines to help with the come down effects of stimulant drugs (such as amphetamines or ecstasy) could result in a cycle of dependence on both types of drug.

Use of more than one drug or type of drug consumed at the same time is called polydrug use.¹⁰

Reducing harm

• Use somewhere safe and around people you trust.
• Avoid mixing with other drugs especially alcohol and opioids.
• Do not use more than recommended or by your prescriber.
• Only use short term as dependence can develop rapidly.
• If injecting, use a clean needle and syringe each time.
• If snorting, crush to a fine powder as large chunks can cause cuts and bleeding.
• Avoid driving or operating machinery if taking benzos.

Novel benzodiazepine

Australia is seeing increased availability of novel benzos as people look for new drug experiences or street alternatives to controlled prescription medicines.⁹

There is limited information on the short and long-term health effects of novel benzodiazepines, but we know that:

• Novel benzos can have similar effects to prescribed benzos but can be stronger and more unpredictable.
• Novel benzos often have similar chemical structures to prescribed benzos.¹⁰
• Novel benzos may vary in strength from batch to batch, and even from tablet to tablet, which increases the risk of toxic effects because the dose cannot be accurately gauged.¹¹
• Novel benzos may contain different drugs (including opioids) and other substances and fillers.¹²
• Between 2015-2021 there were 40 overdose deaths involving novel benzos in Australia.¹³
• And in Victoria, there’s been a sharp increase in deaths from novel benzos - from one in 2018; to 10 in 2019; and, 28 in 2020.¹¹
• There have been a number of health alerts in Australia about fake Xanax, Kalma and Mylan.¹²

Withdrawal from benzodiazepines

Giving up benzodiazepines after a long time is challenging because the body has to get used to functioning without them. So it’s important to seek advice from a health professional when planning to stop taking benzodiazepines. If taking benzodiazepines is suddenly stopped, sudden withdrawal can cause seizures.^4,10

Withdrawal symptoms vary from person to person and are different depending on the type of benzodiazepine being taken. Symptoms can last from a few weeks to a year and can include:

• headaches
• aching or twitching muscles
• dizziness and tremors
• nausea, vomiting, stomach pains
• bizarre dreams, difficulty sleeping, fatigue
• poor concentration
• anxiety and irritability
• altered perception, heightening of senses
• delusions, hallucinations and paranoia
• seizures.³

Getting help

If your use of benzodiazepines is affecting your health, family, relationships, work, school, financial or other life situations, or you’re concerned about a loved one, you can find help and support.

Call the National Alcohol and Other Drug Hotline on 1800 250 015 for free and confidential advice, information and counselling about alcohol and other drugs

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If you're looking for other information or support options, send us an email at druginfo@adf.org.au