Benzodiazepines

What are benzodiazepines?

Benzodiazepines are sedatives and sleeping pills. They are medicines with a calming and relaxing effect (also called tranquilizers, benzos, pammies or tranquilizers). They are prescribed by doctors for sleeping problems, anxiety disorders or to help with alcohol withdrawal. There are many different types of benzodiazepines, almost all of which have names ending in – pam, such as diazepam (Valium), oxazepam (Seresta), and temazepam (Normison).


Effects

The effect of a substance is determined by the properties of the substance itself, but also by the set and setting of the user. Here we describe the effects benzodiazepines generally have.

Positive effects

(negative) Side effects

Relaxation

Reduction of stress, uneasiness, sadness, panic, and feelings of depression.

Slowed breathing

Sorry, this entry is only available in Dutch.

Depressive feelings

Sorry, this entry is only available in Dutch.

Bradycardia (decrease in heart rate)

Sorry, this entry is only available in Dutch.

Sedation

Decreased energy level

Decreased muscle tension

Decreased general tension in the muscles.

Decreased ability to concentrate

Decreased ability to concentrate.

Trembling

Trembling of your limbs.

Dulling of emotions

Dulling of your emotions, apathy.

Increased sensitivity

Increased sensitivity to light, sound and touch, which can be very annoying at times.

Irritation

Quickly annoying or irritated.

Head ache

Sorry, this entry is only available in Dutch.

Decrease in libido

Sorry, this entry is only available in Dutch.

Decreased body temperature

Some drugs cause a decrease in body temperature.

Disinhibition

This substance leads to an increase in impulsive behaviour and can make you less aware of the possible consequences that certain actions have. This can be nice because, for example, it is easier to approach someone and have a chat. However, it can also lead to negative situations as you can get into an argument or physical altercation more quickly.

Increased appetite

Increased appetite and possible weight gain.

Forgetfulness

Forgetfulness. Short term, failure to remember events shortly after ingestion.

Difficulty reading

Sorry, this entry is only available in Dutch.


Dose

Benzodiazepines come in tablet form and are usually taken orally (swallowed). Depending on your complaints and situation (such as age, ethnic origin and medication use), doctors prescribe a certain dose.

There are generally two types of benzodiazepines. The short-acting ones, such as oxazepam (Seresta) and temazepam (Normison) that work for an average of 6-8 hours. And the long-acting ones, such as diazepam (Valium), which work on average for 12 hours. In the medical world, short-acting drugs are recommended for sleep. If you take a long-acting drug, such as diazepam (Valium), it will work the next day, and you may feel drowsy or feel hungover. It is also dangerous to drive the next day because of the sedative effect.

NOTE: only use a benzodiazepine to fall asleep if there is no other option, first try all other ways to fall asleep or get rid of your anxiety.

If you do decide to take a benzodiazepine, keep in mind the following dosage:

To sleep

Temazepam (Normison) 10 – 20mg
Lorazepam (Temesta) 1 – 2.5mg

Longer-acting sleep aids are:
Diazepam (Valium) 5 – 20mg

For fear

Oxazepam (Seresta) 10mg. In principle, you do not fall asleep that quickly, but it does work against anxiety.

NOTE: Each benzodiazepine has a different dosage in milligrams, for example 1 mg lorazepam is equivalent to the effect of 10 mg diazepam. This is also known as dose equivalent. The dosage of each type of benzodiazepine is always different. Therefore, ask your doctor or pharmacy for the correct dose of your benzodiazepine. Benzodiazepines are also offered on the black market, obtained via the internet or via (false) prescriptions. In that case, tablets can contain anything really which makes determining the right dose even more difficult. That’s one of the reasons why experimenting on your own, without a doctor’s advice, is risky.


Duration

There are generally two types of benzodiazepines. The short-acting (average 6-8 hours) and the long-acting (average 12 hours). Benzos also often have a long half-life. This is the time it takes our body to break down half of the active substance. Below you will find the duration of action of a number of common benzodiazepines:

Middel Werkingsduur Half life
Temazepam 8 hours 3 – 19 hours
Lorazepam 8 hours 10 – 20 hours
Diazepam 12 hours 20 – 50 hours

Risks

Short term risks

Traffic
Especially the first week with daily use there is an increased risk of (traffic) accidents due to, among other things, muscle weakness, coordination disorders and a reduced ability to react. We therefore strongly advise against participating in traffic while using benzos. Benzodiazepines have a yellow sticker, ‘may affect driving ability and reaction time’. So if you have used benzodiazepines (which can work for up to 12 hours, so pay close attention to the duration of action) and you cause an accident, then you are not insured for that accident.
With the use of a single tablet, driving ability is also reduced the day after. Therefore, driving the next day is not recommended.

Falls/bone fractures
The muscle relaxation increases the risk of falling and tripping, which in turn can lead to bone fractures. This risk is greater, especially in combination with medicines and/or alcohol and in the elderly.

Rebound phenomena
It is possible that you will suffer from insomnia (one or two nights), because of this there is an increased chance of using again and therefore the risk of addiction.

Overdose
Researchers have developed benzodiazepines in such a way that they affect the brain stem as little as possible, less than, for example, alcohol. Breathing is regulated in the brain stem. As a result, benzodiazepines are less likely to lower the respiratory rate. However, benzodiazepines do have an effect on breathing, so respiratory arrest can always occur at high doses. An overdose of benzodiazepines in combination with other downers such as alcohol can be fatal.

Paradoxical reaction
Very rarely, a paradoxical reaction occurs, ie an opposite reaction with outbursts of anger, irritability, restlessness, anxiety, panic and depression. Exactly how this comes about is unclear. The idea is that people have a genetic predisposition to react paradoxically to benzodiazepines. 1% of individuals who have taken benzodiazepines experience a paradoxical reaction. This is especially common in the elderly and children.

Use during pregnancy
The use of sleeping pills and sedatives can be harmful to the unborn baby. Some benzodiazepines are known to increase the risk of birth defects. Daily use during the last trimester of pregnancy causes withdrawal symptoms in the newborn baby. During breastfeeding, an important part of the active substance ends up in breast milk.

Long term risks

Decreased ability to handle stress

With the use of sleeping pills and sedatives you fight a symptom, the cause is not solved and in the long run you will also have to do something about that cause. The problem is that with prolonged use you are less and less able to absorb stress.

Dulling of emotions

Dulling of your emotions, apathy.

Memory problems

The use of drugs can impair memory. Difficulties can arise in processing information for storage, storage itself, and information retrieval.

Different drugs can cause different memory problems. Some substances can directly cause a (temporary) reduced functioning of the memory. For example alcohol, benzodiazepines, cannabis, MDMA and ketamine. And with some drugs it only comes into play after heavy use. For example with alcohol. This often involves a permanently impaired functioning of the memory. Sometimes there is an improvement after stopping use, for example with cannabis.

Changes in personality

Chronic use of this drug may cause permanent changes in personality or the development of new personality traits. Think of distrust, aggression, paranoia, or arrogance.

Psychological dependency

When someone has a psychological dependency, they are convinced that they cannot function without using the substance.

However, there is no physical change in body chemistry that would produce bodily side effects from quitting the substance.

Physical addiction

Regular use of this drug can lead to physical addiction. This means that in addition to the psychological urge to take more, withdrawal symptoms arise when using is interrupted or stopped. Withdrawal symptoms include but are not limited to: poor sleep, sweating and becoming restless.

Withdrawal symptoms are often a reason to start drinking or using again. In actuality, those phenomena are only temporarily  suppressed.

Tolerance or habituation also occurs. That means if you use it regularly, you need more to feel the same effect.

Tolerance and stimulants

With stimulant use, tolerance will build-up for both the mental changes and appetite-suppressing effect, but not for cardiovascular effects. The higher your dose, the higher your blood pressure.


Interactions

Combining different types of drugs can be risky and unpredictable. When you combine drugs you can have a higher risk of health problems. In the following paragraphs you can read about the effects and the risks of a number of combinations that occur frequently and also a about few that are extra hazardous. Also check our theme combining drugs.

Benzodiazepines and another downer: alcohol or GHB

Both alcohol and benzodiazepines have a depressant effect in the body. They inhibit activity in your brain. The combination could put you in a coma (pass out), suffer a respiratory arrest or choke on your own vomit. Your body can then no longer respond properly if you vomit and if you lie on your back, for example, you can choke on your own vomit. This combination can also lead to unpredictable and reckless behavior. After using benzodiazepines, you often don’t remember what you did.
Keep in mind that some benzodiazepines stay in your body for a very long time. They have a long half-life. So even the day after you take a benzodiazepine, it can still affect another drug that you are taking.

Benzodiazepines and stimulants: ecstasy/MDMA, speed, cocaine, 4-FA

Sometimes people use benzodiazepines to help them sleep after using a stimulant. Read more about that here.
Most importantly, you need to make sure you don’t need a benzodiazepine to sleep. Plan your doses so that you can sleep when you want. If you get used to always having a benzodiazepine on hand, chances are you’ll use more and more often.

  • Do not take uppers a few hours before going to sleep, gradually reduce your party (take it easy, drink tea (without caffeine/theine)).
  • Try to go to sleep without sleeping medication first. Maybe you are tired enough to fall asleep without sleeping pills.
  • Have you tried everything? Are you really not able to sleep? And do you really want to sleep? Then a sedative/benzodiazepine may be an option.
  • Do you realize that when you take a benzo, you mainly rest physically, and less mentally. A benzo inhibits your emotional processing and memory storage.
  • Make sure you have the right dose.
  • Are you taking a benzo? Then go to bed, otherwise you won’t fall asleep.
  • Do not use benzos too often, and only if there is really no other option. Otherwise, you run the risk of becoming addicted to it.
  • Choose a short-acting drug such as temazepam (Normison), this generally works better for sleep and if you take a long-acting drug such as diazepam (Valium) you will be drowsy the day after and you can’t drive a car, for example.
  • Never use benzos for more than 2 weeks in a row if you have severe sleeping problems.

Benzodiazepines and psychedelics

A benzodiazepine may sound like a good solution if someone is having a difficult experience on a psychedelic. Read more about that here. In the best situation, however, you solve it in a different way. See also this article.

  • Persistent bad trip? Try to work it out yourself first, for example by talking to people in your environment, or by changing your environment.
  • Doesn’t all this work? And do you remain afraid or anxious? Then it is possible to take a benzodiazepine, because this inhibits the anxiety. For example, oxazepam (Seresta), and for long-term anxiety suppression diazepam (Valium).
  • Please note: your trip will become less, you will become less anxious, but in principle the drug will continue to work. Only you have a less anxious / intense experience of your trip.
  • Have you had a bad trip? Then find out what caused this. Was it your environment, your friends or are there things in your life that are not going well at the moment, which made your trip negative. You can learn from a bad trip and you can counteract this learning effect by using benzodiazepines. So don’t get into the habit of taking a benzodiazepine too easily to control your trip/turn yourself off.

Unity tips

To minimize health risks, it is recommended that you only use benzodiazepines if prescribed by a doctor, purchase them through legal channels, and adhere to prescribed doses. There can be significant risks associated with the use of benzodiazepines. If you do want to use it, you can limit the risks by:

Unity tips for using drugs

  • When using a drug for the first time, take only a small dose to see how your body reacts to the substance
  • Only use drugs when you are feeling well
  • Use drugs recreationally, not to combat psychological issues like fatigue
  • Avoid using drugs if you have (had) psychological afflictions or if you have a family history of psychological diseases (such as depression) in your family
  • Test your drugs before use at a drugs-testing service
  • Make sure to prepare a good set and setting for drug use
  • Only use drugs sparingly. Keep track of your use over time.
  • Decide in advance how much you are planning to use over the evening, and stick to that. 
  • Do not combine drugs with other substances or medicines
  • Do not participate in traffic after drug use
  • Prevent infectious diseases; Use your own snorter/sniffer and do not share paraphernalia with others
  • After insufflating, rinse your nose well with lukewarm saline water (for example, by using a nasal spray or nasal douche)
  • Are you, or one of your friends not feeling well? Keep an eye out for one another, take care of each other and visit the first aid (if one is available)
  • Call 112 in a life-threatening situation
  • Eat healthy before and after drug use. In particular, foods with lots of antioxidants and vitamins (blueberries, raspberries, blackberries, grapes, raisins, oranges, kiwi, broccoli). This is perhaps the most important tip! It can be difficult to eat during and after drug use, but make sure to try to eat something anyway. Eating well is a great way to reduce the hangover! If you can’t hold in solid foods, try juices, breakfast drinks, and smoothies.

Unity tips for using sedatives

  • Do not use sedatives (downers) in combination with other sedatives (alcohol, GHB, sleeping pills, opiates) or ketamine. This is dangerous because you can fall unconscious and suffocate on your vomit.
  • Write down the time of intake and your dose, text the dose and time to each other or put it in your phone to keep track of it yourself.
  • If you feel that you are getting falling asleep, you can try to keep moving to avoid falling asleep. But beware; if moving takes a lot of effort, there is a chance that you may fall or trip, so be careful.
  • An overdose is more likely on an empty stomach, a full stomach increases the chance of vomiting.
  • Less is more; taking a small, extra dose later because you did not feel anything after your first dose is better than taking too much and having an overdose.
  • Ensure that the people around you are aware of what you are going to use and have been using.

Do not use benzodiazepines in: hypersensitivity, myasthenia (muscle weakness), severe liver dysfunction, severe breathing problems and sleep apnea syndrome.

Caution is advised in the elderly, with damage to the central nervous system, with intoxication with sedatives and with (a history of) alcohol or drug use.


FAQ

How did the use of benzodiazepines start?

Benzodiazepines have had a number of predecessors. In the past, alcohol, opium and herbs were used as nightcaps or to numb pain. At the beginning of the twentieth century, a new drug was made in laboratories: barbital, a so-called bariburate.

Over the years, barbiturates have been shown to be very dangerous (highly addictive and high risk of fatal overdose). Benzodiazepines proved to be less dangerous and have almost completely replaced the barbiturates.

Benzodiazepines have been used since 1960 in patients with anxiety and sleep complaints. The first benzodiazepine, chlordiazepoxide (Librium), was discovered by the Austrian Leo Sternbach. Shortly afterwards in 1963, diazepam (Valium) was developed, a drug that is still widely used in medicine today.

But the benzodiazepines were also found to cause addiction problems. Especially the fast-acting benzodiazepines are also used in the illegal drug world because of the intoxicating effect they can cause.

What about the laws regarding benzodiazepines?

Most benzodiazepines fall under the Medicines Act and are on list II of the Opium Act. The medicine should only be prescribed by a doctor and dispensed by a pharmacist. In addition, (non-prescribed) possession of and trade in benzodiazepines is punishable by law.

Some benzodiazepines or derivatives thereof (thienotriazolodiazepines, for example, to which etizolam belongs) are not covered by the Medicines Act, but by the Commodities Act. It is difficult to say whether something falls under the Medicines Act or the Commodities Act. There is no list of substances that fall under the Medicines Act. That should be looked at on a case-by-case basis. Because etizolam is used as a medicine in Italy, it will again fall under the Medicines Act in the Netherlands.

What if I have medical complaints after the use of partydrugs?

Some complaints after using drugs can last longer, A medical explanation or even treatment may then be necessary. The Brijder has set up a national consultancy for party drugs related medical complaints. If you have medical complaints after the use of party drugs, you can call the consultancy: 088 – 358 29 40. This service is only available in the Netherlands.

 

Are benzodiazepines addictive?

If you use benzodiazepines too often, you run the risk of becoming mentally and physically addicted to them. This often starts with the idea that you can’t sleep without benzodiazepines (for example, after taking drugs). You lose faith in your own ability to fall asleep and then become mentally dependent on them. In the long run, you can also become physically dependent if you take benzodiazepines on a daily basis. After a few weeks/months, tolerance to benzodiazepines develops and you need more and more to achieve the same effect. It is often very difficult to get rid of a benzodiazepine addiction, because sleeping problems and anxiety symptoms often return when people stop taking benzodiazepines.

Withdrawal Symptoms

So you can become physically dependent on benzodiazepines. When you then reduce or try to stop, you will experience withdrawal symptoms: headache, sweating, speech and vision disorders, dizziness, tremors, nausea or shortness of breath, anxiety, irritability or depressive feelings. Let this be precisely the complaints why people often started using, it is logical that people are inclined to use again, that is called a vicious circle.

Never stop daily benzodiazepine use all at once, as this can cause dangerous physical withdrawal symptoms. It is important to do this in consultation with a professional, who can help you with a reduction schedule and you can also look together at the cause of your anxiety or sleeping problems.

If you’re wondering if your benzodiazepine use is becoming a problem, you can take a “test your own use” test on Jellinek’s website.

What is the impact of benzodiazepines on your sleep pattern?

What are the effects of benzodiazepines on your sleeping pattern? And what happens when you combine benzodiazepines with stimulants? You can read the answers to those questions in this article.

What are the risks of combining benzodiazepines with other drugs?

Combining different drugs or drugs and medications can be risky and unpredictable. If you combine, you are more likely to have problems with your health. Here we describe the effects and risks of a number of combinations that are common or that are risky. Also check combination use. The Jellinek website contains a drug matrix, where you can read what the risks are per drug and per type of drug.

Benzos and narcotics (downers, e.g. alcohol, ketamine, GHB)

Never use benzodiazepines in combination with alcohol, ketamine, GHB or other downers. The combination could put you in a coma, stop breathing or choke on your own vomit. This combination can also lead to unpredictable and reckless behavior with all the associated risks.

Benzos and other medicines

Do not combine benzodiazepines with drugs that lower consciousness: such as antipsychotics, other benzodiazepines or sleeping pills or antihistamines. The combination of these agents can cause an extra lowering of your consciousness.


Read more

Read more on benzodiazepines on: