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What are the signs and symptoms of Benzodiazepine abuse?

Benzodiazepines, aka benzos, are a class of drugs commonly referred to as tranquilizers. They are available by prescription only, and have a variety of medical uses, such as treatment of insomnia, pre-op sedation, relief of anxiety, prevention of panic attacks, and for emergency management of a seizure. They can also be used as muscle relaxants. Benzodiazepines are also a popular drug for diversion, or illicit sale. They are crushed and snorted, crushed and mixed with water and injected, or swallowed. They are also used to enhance the effects of other drugs such as opiates or alcohol, or to come down form the high of cocaine, crack, or methamphetamine

What are Benzodiazepines?

Benzodiazepines are available in pill form or an oral suspension for swallowing, or a sterile liquid form for IV use. The sizes, shapes, colors, and lettering, numbering, or symbol imprints widely vary, depending on the type of benzodiazepine, the manufacturer, and the dose.

How benzodiazepines are used?

Typically benzodiazepines will be swallowed when taken for a legitimate medical reason, and with a prescription. In an inpatient setting, such as a hospital, they may be given intravenously if there is an emergency to manage, such as a seizure. Illicit use consists of crushing the pill form, mixing it in water and injecting it, or crushing a pill and snorting it for a quicker and more intense high.

Effects of benzodiazepines on the user

Someone who has ingested, snorted, or injected a benzodiazepine will: 

  • Feel very pleasantly relaxed
  • Be indifferent about problems and concerns
  • Feel apathy about responsibilities
  • Experience a loss of inhibition, saying whatever they are thinking
  • Display a labile or unstable mood, lethargy and drowsiness, and slurred speech
  • Ataxia, or a staggering gait
  • Retro-grade amnesia (Blackout/Brownout)

How long benzodiazepines take to work, and how long they last?

The effects of benzodiazepines appear seconds after IV administration, about 20 to 40 minutes after oral use, and within seconds after snorting them. The duration of action of is up to  24 hours, depending on the type that is used. There are ultra-short acting benzodiazepines which only last for about 30 to 60 minutes, such as Versed, and long acting benzodiazepines such as Valium which last for 18 to 24 hours.

Short-term and long-term risks of using benzodiazepines  

Benzodiazepines will produce a characteristic withdrawal syndrome upon cessation of use, including:

  • Anxiety
  • Agitation and restlessness
  • Insomnia
  • Gasping and gulping air
  • Tremors and twitching
  • Grand mal seizures
  • Respiratory arrest

The withdrawal symptoms can be life threatening. When benzodiazepines use is to be discontinued it must be a gradual process called titration. The dose is gradually reduced over a period of weeks or even months, to prevent an extreme response.

Conclusion

Benzodiazepines should only be used when prescribed by a physician, and taken as prescribed for the shortest period possible, or intermittently as needed. They are very physiologically addictive, and produce life-threatening withdrawal symptoms. There are safer alternatives for management of anxiety and insomnia, including other lower-risk medications, psychotherapy, and lifestyle changes.