Benzodiazepines

Benzodiazepines are pharmaceutical preparations used for treating anxiety and insomnia, among other things. [1] Benzodiazepines are widely used without a doctor’s prescription. In such cases, it is considered misuse. It is also considered misuse when the medication is taken in doses higher than the recommended therapeutic amount. [2]

Commonly misused benzodiazepines include diazepam, clonazepam, alprazolam, and oxazepam. [1] On the illegal market, benzodiazepines are sold as tablets, capsules, and powders. Some of these preparations come from illicit laboratories. Counterfeits do not correspond in composition to pharmacy-grade products. [3] For recreational use, benzodiazepines are taken orally, snorted, or injected intravenously. [1]

Legal status: Benzodiazepine compounds are classified as both medicinal and narcotic substances. Their use, purchase, and possession without a doctor’s prescription is prohibited. [4] [5]

How does it work?

The effect is central nervous system depressant. Benzodiazepines bind to GABAA receptors. They enhance the action of gamma-aminobutyric acid (GABA) at these receptors. [6] [7] The onset and duration of benzodiazepines’ effects vary depending on the substance. The most fat-soluble benzodiazepines (such as diazepam and oxazepam) are absorbed the fastest. Half-lives vary from less than five to more than 12 hours. [8]

Desired effects: In both therapeutic and recreational use, benzodiazepines relieve anxiety, restlessness, and fear. They relax both the mind and the muscles. [7] Benzodiazepines are also illegally used to enhance the effects of other drugs. They are also used for self-medicating withdrawal and side effects from other substances. [9] [10]

Side effects: Fatigue is the most common side effect of benzodiazepines. [6] [9] Other possible effects include memory and concentration difficulties, impaired motor skills, depression, confusion, restlessness, muscle weakness, and reduced sexual desire. [6] [7] [9] These side effects are more pronounced with recreational use due to higher doses than in medical use. [9] Although benzodiazepines are calming drugs, they can in some cases cause unpredictable behavior, such as aggression. [11]

Key risks

Acute risks: Especially in individuals unaccustomed to benzodiazepines, usage can lead to grogginess, drowsiness, and clumsiness. These effects pose a risk, particularly in traffic. [12] [13]

Benzodiazepines alone have not caused fatal poisonings or overdoses. However, in combination with alcohol and other central nervous system depressants, they contribute to most drug-related deaths. [12]

Polydrug use risks: Combining depressants (alcohol, opioids, gabapentinoids) with benzodiazepines is extremely dangerous. These substances enhance each other’s effects, which can lead to unconsciousness and respiratory depression. [12] In deaths involving benzodiazepines, alcohol, and opioids, death typically occurs while the person is sleeping. [14] [15]

Heavy use risks: Benzodiazepines cause brain damage over time. [11] They affect cognitive abilities such as speech production and memory in both adults and children. [6] [7] [14] Even in medical use, long-term benzodiazepine use is not recommended due to their addictive potential. [16]

Intravenous use of benzodiazepines carries the risk of serious infectious diseases such as HIV and hepatitis C. [17] [18] Hepatitis C infection is the most common injection-related harm: in Finland, approximately 75% of people who inject drugs have contracted the virus. [17] [19] Injection can also lead to local infections. Infection can occur if fungi or bacteria enter the bloodstream during injection. Injecting tablets can cause talc (present in tablets) to accumulate in the lungs, which can lead to a lung disease known as talcosis. [19]

Addiction: Benzodiazepines are among the most addictive pharmaceutical substances. Addiction is estimated to develop in about ten percent of users. [10] Withdrawal symptoms typically appear within a few days of stopping use. Symptoms may include nervousness, restlessness, anxiety, loss of appetite, irritability, sleep disturbances, muscle stiffness, palpitations, and confusion. The likelihood of withdrawal symptoms increases with longer duration and higher dosage of use. [21] [22]

Use during pregnancy: There is some evidence that benzodiazepine use during pregnancy may cause birth defects. However, the risk is likely very small. If the mother has used large amounts of benzodiazepines during pregnancy, the newborn may exhibit mild withdrawal symptoms. [7] Use during pregnancy should always be discussed with a doctor.

How can risks be reduced?

Sedatives and tranquilizers should never be combined with other depressant substances such as alcohol or opioids. When combined with these, benzodiazepines significantly increase the risk of overdose.

Some of the risks related to use can be avoided by not injecting the substance. However, if benzodiazepines are used intravenously, it is of utmost importance to always use one’s own clean injection equipment and preparation containers. This is the best way to prevent infectious disease risks associated with intravenous use. Used needles and syringes can be exchanged for clean ones at health counseling centers.

If tablets are used intravenously, it is essential to filter out the tablet binders from the injection solution using special filters available at health counseling centers. This prevents the accumulation of binders in the body and clogging of small capillaries.