benzodiazepines
BENZOS A drug user’s guide
This booklet provides information for people who use benzodiazepines (benzos). The National Drug & Alcohol Research Centre (NDARC) has conducted many interviews with injecting drug users who have used benzos. Many of those interviewed have requested more information on these medications.
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What are benzos? Benzos (or benzodiazepines) are sometimes referred to as minor tranquillisers, pills or sleepers. Some of the more common benzos are listed below. Generic name
Trade name
alprazolam
Xanax
clonazepam
Rivotril
diazepam
Antenex, Diazemuls, Ducene, Valium
nitrazepam
Alodorn, Mogadon
oxazepam
Alepam, Murelax, Serepax
temazepam
Euhypnos, Normison, Temaze
Like alcohol, heroin and cannabis, benzos are ‘downers’. They affect the central nervous system by slowing down the body physically, mentally and emotionally.
What are benzos used for? Benzos are usually prescribed by doctors to treat anxiety and sleep problems. They are also used in the treatment of epilepsy, alcohol withdrawal, and muscle spasms.
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Why do drug users use benzos? Opiate users tend to use benzos when they can’t get opiates, when trying to stop using, or to increase the effect of opiates. Methamphetamine and cocaine users tend to use benzos to help them sleep when coming down. For some people benzos are their drug of choice. If you are using benzos with other drugs it is really important that you are aware of the risks involved.
What harms are associated with benzo use? Benzo dependence and withdrawal Just like heroin and alcohol, you can become dependent on benzos. Our studies have shown that of those heroin users who use benzos, more than one in five are dependent on them. Similarly, one third to a half of methamphetamine users use benzos at levels that could lead to dependence.
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Symptoms of benzo dependence include: • Wanting to stop or cut down on benzo use without being able to • Using larger amounts of benzos or using for longer periods than intended • Having to take more benzos than you are used to in order to get the same effect (tolerance) • Spending a lot of time getting hold of benzos, using them or getting over their effects • Continuing to use benzos despite physical or psychological problems associated with their use • Neglecting important activities to get hold of or use benzos • Experiencing withdrawal symptoms upon cessation of benzo use/continuing to use benzos to keep from having withdrawal symptoms Even if benzos are not your main drug, using them may still cause you problems. Basically, the longer you use benzos, and the more tablets you take, the greater your risk of becoming dependent on them. Try and avoid taking them for longer than a week at a time, or use as prescribed by your doctor. People who are dependent on benzos may experience withdrawal symptoms when they attempt to stop using them. 4
The signs and symptoms of withdrawal include: HEADACHES
NAUSEA
ANXIETY
INABILITY TO SLEEP
LOSS OF APPETITE
TREMORS
VISUAL DISTURBANCES
HEARING DISTURBANCES
SWEATING
GUT DISTURBANCES
HALLUCINATIONS
FITS
When the withdrawal symptoms will start, and how long they last will be determined partly by whether the benzos being used are long-acting (like diazepam) or short-acting (like temazepam). If a combination of long-acting and short-acting benzos have been used, then withdrawal is likely to last longer.
Overdose Heroin and benzos can be a deadly combination. Benzos are involved in one out of every four heroin related deaths. With benzos in your system it takes less heroin to overdose. 5
If you’ve been bingeing on benzos, there is a good chance that there will still be a high level of benzos in your bloodstream the next day. Some heroin users have reported overdosing from their normal shot of heroin the day after heavy benzo use. Using alcohol and benzos with heroin further increases your risk of dying from an overdose. Heroin, benzos and alcohol are all depressant drugs that slow down the functions of the central nervous system. Importantly, they can all reduce a person’s breathing rate.
BENZOS HEROIN ALCOHOL
To reduce the risk of overdose, avoid using heroin, alcohol or benzos together.
If you feel you must use benzos and/or heroin, make sure that you don’t use alone. People who use alone are at far greater risk of dying from heroin overdose. Have someone with you whom you can trust, who knows what you have used, and who isn’t going to be too out of it to get help when something goes wrong. 6
Injection related harms Research has shown that many people who inject drugs have injected benzos. The main reason being that they were after a better effect/rush from the tablets. One of the main reasons users gave for giving up injecting pills was that the rush was not that great. The other main reasons given for stopping the injection of pills related to health concerns, including having had a thrombosis (clot), chest pain, overdose and endocarditis (heart infection). Injecting benzos, either in a tablet or liquid gel form, is highly problematic and potentially dangerous. They are intended for oral use only and injecting them can have severe health effects including: • Collapsed veins • Cellulitis (red, swollen, infected skin) • Loss of limbs due to poor circulation • Damage to major organs (e.g. heart, kidneys etc.) • Stroke (even death) 7
How do you get off benzos? If you have been using high doses of benzos or have been taking benzos on a regular basis, do not stop your benzo use abruptly, as this may give rise to serious complications such as hallucinations and fits. See your doctor and they can help you to gradually reduce the dose of benzos that you are taking, thereby preventing any serious withdrawal problems. When determining the best way for you to cut down, your doctor will consider what dose of benzos you have been taking, the type of benzos and the length of time you have been using them. Getting by without benzos may be difficult at first. It may be useful to develop some alternative strategies for coping with stress and/or insomnia. Relaxation techniques can be very useful in managing these problems. Your doctor may be able to teach you some basic relaxation techniques, if not, see if they can refer you to someone who can.
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If you suffer from anxiety and/or insomnia, keep in mind that they may simply be symptoms of benzo withdrawal, in which case these symptoms will eventually stop. Try and work out what triggers your desire to use benzos. Are there certain situations in which your desire to use benzos is increased? If so, what can you do to cope with these situations or triggers? Keeping a diary of your benzo use for one week may help you to identify these situations. Try talking to your doctor or a drug counsellor about these situations. Maybe book yourself into a supportive rehab or detox. It is important to realise that some people do not succeed at their first attempt to get off benzos. It may take several attempts before you are successful, but with each attempt you will learn more about the withdrawal process and how to manage the symptoms.
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This booklet was rewritten by Dr. Joanne Ross and Prof. Shane Darke in 2013 and reviewed by Dr. Courtney Breen The current version of this book was designed by: John Fear This booklet was produced by The National Drug and Alcohol Research Centre Education Trust (NET): www.neteducate.org Copies of this booklet can be purchased online by order on the website: www.neteducate.org NDARC Education Trust (NET) PO Box 21, Randwick NSW 2031 Tel: 02 9385 0333 Fax: 02 9385 0222
Disclaimer: All information contained in this booklet was correct at the time of publication Š2013. This publication supersedes the original published in 1998 by the same author. For more information please refer to LINKS on the NET Website: www.neteducate.org
ISBN 978-0-7334-3339-9