Do You Know... Benzodiazepines

Updated June 30, 2005 3:31 PM

Generic and trade names: alprazolam (Xanax®), clonazepam (Rivotril®), diazepam (Valium®), flurazepam (Dalmane®), lorazepam (Ativan®), temazepam (Restoril®), triazolam (Halcion®) and others

Street names: benzos, tranks, downers

What are they?
Benzodiazepines are a family of prescription drugs that are used mainly to relieve anxiety and to help people sleep. These are sedative drugs, which reduce activity in certain parts of your brain, resulting in a calming effect.

Other uses of benzodiazepines include:

inducing sedation for surgical and other medical procedures
treatment of alcohol withdrawal
controlling seizures
relaxation of skeletal muscles, such as the back and neck.
Because they are safer and equally effective, benzodiazepines have replaced older drugs with similar effects, such as barbiturates. There are currently over 50 benzodiazepines in use throughout the world; 14 of these are available in Canada. In Canada and the United States, benzodiazepines are available legally only by prescription.

Where do benzodiazepines come from?
All drugs in this family are chemical compounds that are made in the laboratories of pharmaceutical companies.

What do benzodiazepines look like?
Benzodiazepines are usually in the form of tablets or capsules, in various colours, which are taken orally. A few of them are also prepared as a solution for injection.

Who uses benzodiazepines?
Approximately 10 percent of Canadians report using a benzodiazepine at least once a year, with one in 10 of these people continuing use regularly for more than a year. Although use of these drugs has declined in recent years, they are still one of the most widely prescribed drugs in Canada. Women are prescribed benzodiazepines twice as often as men, and a large proportion of these drugs are prescribed to older adults.

Non-medical use of benzodiazepines does occur, especially among people who abuse other drugs. Some people who abuse other drugs use benzodiazepines to enhance the effect of other sedative drugs, such as opioids and alcohol, or to ease the agitation of drugs that have stimulant effects, such as ecstasy or cocaine. Taking benzodiazepines in combination with other drugs can be dangerous. Even though women are prescribed benzodiazepines more often than men, an equal number of women and men are treated for misuse of benzodiazepines.

How do benzodiazepines make you feel?
Low to moderate doses of benzodiazepines can relieve mild to moderate anxiety and make you feel relaxed and calm. Higher doses can relieve insomnia and severe states of emotional distress, and may make you feel drowsy and possibly clumsy.

Benzodiazepines can impair the ability to learn and remember new information, as well as interfere with the ability to perform certain physical and mental tasks. Learning, memory and performance return to normal once the effect of the drug has worn off.

Side-effects such as confusion, disorientation, amnesia, depression and dizziness may be experienced by some people who take benzodiazepines. Other possible effects, which are extremely rare, include agitation and hallucinations.

The way benzodiazepines affect you depends on many factors, including:

what condition the medication was prescribed to treat, and the severity of the condition
the type of benzodiazepine you take
how much you take and how often you take it
how long you’ve been taking it
if you’ve taken any alcohol or other drugs (illicit, prescription, over-the-counter or herbal).
How long does the feeling last?
When taken by mouth, the effects of benzodiazepines may be felt within 30 to 40 minutes or within two to four hours, depending on the type taken. Most benzodiazepines have effects that are felt for several hours. The time it takes to eliminate these drugs from the body also varies depending on the type taken, and ranges from days to weeks.

Are benzodiazepines dangerous?
When taken as prescribed, for only a few weeks or months, benzodiazepines are safe. However, as with any other medications, there can be dangers associated with the use of these drugs:

Benzodiazepines can affect your ability to drive a vehicle or operate equipment safely, and increase the risk of collision, especially if taken in combination with alcohol or certain other drugs.

When used to induce sleep, benzodiazepines may have some “hangover” effects, such as morning and daytime drowsiness, which may impair your ability to perform tasks requiring alertness.

Sensitivity to the effects of benzodiazepines increases with age. When older adults take these drugs, they may become confused and have reduced muscle co-ordination, putting them at greater risk of falls, hip fractures and automobile accidents.

Regular use of benzodiazepines should be reduced gradually. When high doses have been used, medical help may be required. Stopping high-dose use abruptly may cause severe withdrawal symptoms.

Dying from an overdose of benzodiazepines alone is rare. Risk of overdose increases when benzodiazepines are combined with other sedatives, such as alcohol or barbiturates, or with medications containing codeine or other opioid drugs. Possible overdose symptoms include slurred speech, confusion, severe drowsiness, weakness and staggering, slow heartbeat, breathing problems and unconsciousness.

Combined use of benzodiazepines and methadone is particularly dangerous, and may be fatal.

The risk of birth defects from taking benzodiazepines while pregnant has not been well established. If
benzodiazepines are used regularly during pregnancy and particularly close to delivery date, there may be withdrawal symptoms in the newborn.

Benzodiazepines are excreted through breast milk, which means they are passed on to the baby.

Certain benzodiazepines have been associated with the facilitation of sexual assault, or “date rape.” For more information, see Do You Know… Rohypnol.
Are benzodiazepines addictive?
Psychological and/or physical dependence may develop with the use of benzodiazepines in some people in certain circumstances. The risk of dependence increases when benzodiazepines are taken regularly for more than a few months, especially when they are taken in higher than normal doses.

People who use benzodiazepines may develop tolerance to some of their effects. This means that the same dose taken over time no longer has the desired effect. Some people who develop tolerance may take higher and higher doses to feel the same intensity of effect as when they started taking the drug.

People who use benzodiazepines for insomnia often develop tolerance to the sleep-inducing effects within a few weeks of regular use; however, tolerance does not usually develop with occasional use. People who use benzodiazepines for anxiety rarely develop tolerance to the anxiety-relieving effects, and rarely increase their dose or lose control over their use of the drug. Tolerance to the effects of one type of benzodiazepine leads to tolerance to other benzodiazepines, and to other drugs with similar effects, including alcohol.

People are said to be psychologically dependent when they have a strong craving for the effects of the drug, and feel compelled to take it, even when the drug does not produce the desired effects. Stopping use of benzodiazepines can be difficult for these people.

People who are psychologically dependent may or may not also be physically dependent. People who are physically dependent will experience withdrawal symptoms if they stop using the drug abruptly. 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. Withdrawal symptoms can include headache, insomnia, tension, sweating, difficulty concentrating, tremor, sensory disturbances, fear and 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. Long-term regular use of benzodiazepines should be reduced gradually, with medical supervision.

What are the long-term effects of taking benzodiazepines?
If prescribed by your physician, taken at recommended doses for periods of only weeks or months, and not taken with alcohol or certain other medications, benzodiazepines are safe medications.

--------------------------------------------------------------------------------

©2003 Centre for Addiction and Mental Health. A PAHO/WHO Collaborating Centre.
Fully affiliated with the University of Toronto.

DISCLAIMER: Information on this site is not to be used for diagnosis, treatment or referral services and CAMH does not provide diagnostic, treatment or referral services through the Internet. Individuals should contact their personal physician, and/or their local addiction or mental health agency for further information.

ID#P13445 published April 11, 2006 10:48 AM