What Are Benzodiazepines?
Benzodiazepines, sometimes called benzos, are a type of medication known as tranquilizers. Familiar names include Valium and Xanax. These drugs slow down your central nervous system, cause sedation and muscle relaxation, and lower anxiety levels. Often used to treat anxiety or insomnia, they're some of the most commonly prescribed medications in the U.S. But they can be addictive, especially if you take them every day or use them long-term.
Benzodiazepine drugs are also sometimes used as "date rape" drugs because they impair the functions that normally allow a person to resist sexual aggression or assault. The drug is usually added to alcoholic drinks or even soft drinks in powder or liquid forms and can be hard to taste.
What are some other names for benzos?
You might hear them called Valium, Xanax, Ativan, Librium, xannies, vallies, roofies, tranks, downers, goofballs, Mexican, roach, heavenly blues, valo, stupefi, anxiety drugs, date rape drugs, or club drugs.
Are Benzodiazepines Legal?
Benzodiazepines are a controlled substance, which means it's illegal to have them without a doctor's prescription. Legally manufactured forms of benzodiazepine are classified as schedule IV drugs in the U.S.
Synthetic benzodiazepines, sometimes called "street," "designer," or "novel" benzos, are classified as schedule I. That means they're considered highly addictive. These drugs are made in illicit labs and sold for recreational use.
Does benzodiazepine show up on a drug test?
A drug test can detect the presence of most benzodiazepines or their metabolites (substances produced when the drugs break down in your body). But some types don't always show up. And most tests can't tell how much of the drug is present.
Although more than 2,000 different benzodiazepines have been produced, only about 15 are currently FDA-approved in the U.S. They're usually classified by how long their effects last:
- Ultra-short acting: Midazolam (Nayzilam, Seizalam), triazolam (Halcion)
- Short-acting: Alprazolam (Xanax), lorazepam (Ativan , Loreev), temazepam (Restoril)
- Long-acting: Chlordiazepoxide (formerly sold as Librium), clonazepam (Klonopin), diazepam (Valium)
Other commonly prescribed benzodiazepines include:
- Clobazam (Onfi, Sympazan)
- Clorazepate (Tranxene)
- Quazepam (Doral)
- Remimazolam (Byfavo)
One type of benzodiazepine that's legally manufactured in other countries but illegal in the U.S. is flunitrazepam (Rohypnol). Often called "roofies," it's well known as a date rape drug.
Some synthetic (illicit) benzodiazepines are:
What are nonbenzodiazepines?
Nonbenzodiazepines are a newer type of drug whose effects are similar to those of benzodiazepines. These drugs are usually prescribed to treat sleep disorders. They include:
- Eszopiclone (Lunesta)
- Zaleplon (Sonata)
- Zolpidem (Ambien)
Doctors may prescribe benzodiazepines for these reasons:
- Alcohol withdrawal
- Seizure control
- Muscle relaxation
- Inducing amnesia for uncomfortable medical procedures
- Given before an anesthetic (such as before surgery)
How are benzos used?
Benzodiazepines are used recreationally for their mood-boosting effects. The pills are generally taken by mouth. But some people crush them and smoke, snort, or even inject the drug.
Users of heroin and other opioids sometimes take them to boost their highs. Some people also use them to try to ease the comedown from cocaine or other stimulants. Using benzos along with other drugs, especially "downers" like opioids, is particularly risky.
Dosing differs depending on which benzodiazepine you take, as well as things like your size, gender, and whether you're used to taking them. How long they take to start working, and how long their effects last, can vary from drug to drug.
For example, a common dose of alprazolam (Xanax) is 0.5 to 1.5 milligrams. It takes 20-40 minutes to take effect, and its effects last 5-8 hours. For diazepam (Valium), a common dose is 5-15 milligrams. It takes 15-40 minutes to start working and lasts 5-8 hours.
When you buy them illegally for recreational use, you can't be sure what dose you're getting or exactly what they contain.
The abuse of benzodiazepines is related to both the effects they produce and to their widespread availability. They can be chronically misused or, as seen more commonly in hospital emergency departments, intentionally or accidentally taken in overdose.
Benzodiazepine abuse alone rarely causes serious illness or death. But people often take them with alcohol or other drugs, either of which can be dangerous or even deadly. About 3/4 of deaths that involve benzodiazepines also involve an opioid drug.
Benzodiazepines can lead to both physical and psychological dependence. If you become dependent on the drugs, you can have withdrawal symptoms and even seizures when you suddenly stop taking them. Only a very small percentage of people who take normal doses for short periods will become dependent on benzodiazepines.
It can be hard to tell the difference between withdrawal symptoms and anxiety. Withdrawal symptoms usually show up anywhere from 3-4 days to 2 weeks after you last use the drug. But they can appear earlier with shorter-acting types of benzodiazepines.
Taking too much and running out of your prescription, being overly focused on when you can take the next one, and feeling you can’t live without it could be signs that you're developing a benzodiazepine use disorder.
Signs of chronic misuse or dependence can be hard to spot in others. They may include changes in appearance and behavior that affect relationships and work performance. In children, you might notice sudden changes in mood or a decline in school performance. Long-term (chronic) misuse of benzodiazepines can lead to these symptoms:
- Appetite loss (anorexia)
At regular doses, benzodiazepines help to relieve anxiety and insomnia. Most people tolerate them well.
Other effects may include:
Benzodiazepine Side Effects
These drugs can cause sometimes serious side effects, especially when you take higher doses of them. Benzodiazepines' side effects include:
- Confusion, memory loss, and other thinking problems
- Slurred speech
- Lack of coordination
- Sadness, feelings of isolation, or thoughts of suicide
- Dry mouth
- Blurry vision or double vision
- Nausea and appetite loss
- Constipation or diarrhea
- "Flattened" mood
- Aggression, which is most common when you use them with alcohol
- Memory loss or blackouts
Injecting these drugs can lead to
Damage to your veins
Infections like hepatitis or HIV
Deep vein thrombosis and other blood clots, which can be dangerous and sometimes fatal
Benzodiazepines and alcohol
Mixing alcohol with benzodiazepines is dangerous, since both drugs have sedating effects. Using them together raises your risk for overdose and makes you more likely to have side effects like:
Problems thinking and concentrating
Doctors recommend waiting until all benzodiazepines pass out of your system before you drink alcohol. That could take up to 20 hours for shorter-acting drugs like alprazolam (Xanax) and lorazepam (Ativan, Loreev). For longer-acting drugs like chlordiazepoxide, clonazepam (Klonopin), and diazepam (Valium), it could take up to 3 days.
Protecting yourself from date rape
Along with flunitrazepam (Rohypnol), alprazolam (Xanax) and clonazepam (Klonapin) may be used to incapacitate sexual assault victims. Not only do they affect your judgment, but these drugs can keep you from remembering what happened.
To protect yourself against this kind of assault:
Don't leave your drink unattended.
Don't accept drinks from people you don't know well.
Avoid drinking from shared containers like pitchers or punchbowls.
Go to parties and clubs with a group of friends, and stay with them.
If you think you or someone you're with has had a spiked drink, get medical help right away.
Long-term benzos effects
Along with dependency, regular use of benzodiazepines could lead to these long-term effects:
- Depression and/or anxiety
- Thinking and memory issues
- Loss of motivation and initiative
- Changes in personality
- Sleep problems and daytime drowsiness
- Irritability and aggression
- Stomach issues
- Skin rashes
- Weight gain
Benzodiazepines and Harm Reduction
While it's always risky to take drugs that a doctor hasn't prescribed for you, there are some ways to reduce the potential for harm:
- Start with a low dose since you can't be sure how strong the drugs you're using are.
- Avoid taking additional doses. Benzos affect your memory, so it can be hard to recall how much you've taken.
- Don't use them along with other drugs, especially alcohol or opioids.
- Make sure you're in a safe place, with people you trust, before you take them.
- Never drive or operate machinery while using them.
- Taking them as pills is less dangerous than snorting or injecting them.
- Don't use them regularly, since they're very addictive and you can build a tolerance quickly.
- If you think you're becoming dependent on benzodiazepines, get professional help. Stopping them suddenly can be dangerous.
Symptoms of a benxodiazepine overdose may include:
- Extreme sleepiness
- Blurred vision
- Slurred speech
- Lack of coordination
- Trouble breathing
- Loss of consciousness or coma
if you think you or someone you're with is in danger of overdosing, call 911 right away. Keep in mind that emergency responders and doctors are there to help you. They don't need to notify the police. If you have the pill containers, give them to the EMTs or doctors to help them determine the number and type of pills taken.
What treatment looks like
If you go to the emergency room for a possible drug overdose, doctors will assess how well you're breathing and ensure you have a normal heartbeat. The rest of the work-up depends on you and your symptoms:
- You'll usually be placed on a monitor that evaluates your heart rate, blood pressure, and how much oxygen is in your bloodstream. An IV line will be started. You'll get oxygen if you're short of breath or have a reduced level of consciousness.
- You may get a urine drug screen. These lab tests can detect many commonly abused drugs, including benzodiazepines. But they don't show how much you took.
- Blood samples, EKGs, and chest X-rays may be done if there's concern you may have taken other dangerous drugs.
The treatment for an overdose usually depends on what drugs you took and how much:
- If you took the drugs within the past 1-2 hours, you might get gastric lavage. In this procedure, a health care worker places a tube directly into your stomach through your mouth or nose. Then, they push water into your stomach to wash out the pill fragments. This is done only if you've also swallowed other, potentially more deadly, drugs.
- A single dose of activated charcoal is recommended if you come to the emergency department within 4 hours of taking the drugs. It's a black powder that's mixed with water that you then drink. It helps keep your body from absorbing the drugs. Side effects include nausea, vomiting, and abdominal cramps.
- There's an antidote to reverse the effects of benzodiazepines called flumazenil (Romazicon). But it's usually reserved for serious cases. It can cause withdrawal and seizures in people who abuse benzos. You may need repeated dosages.
If doctors think you may have overdosed on purpose or are at risk of harming yourself or others, you may see a psychiatrist or addiction specialist before you leave the hospital.
Benzodiazepine Abuse Causes
One of the main reasons benzodiazepines are misused is because they're so widely available. Prescriptions filled in 2021 alone in the U.S. included:
- 34.6 million for alprazolam (Xanax)
- 23.7 million for clonazepam (Klonopin)
- 21.3 million for lorazepam (Ativan, Loreev)
- 9.1 million for diazepam (Valium)
- 4.7 million for temazepam (Restoril)
Some people who are prescribed benzodiazepines become dependent on them and end up misusing them. Others get them illegally and intentionally misuse them to get high. If you use them for a long time, you can build up a tolerance. That means you need higher and higher doses to get the same effect.
People with a family history of substance abuse, or who have misused substances before, are at higher risk for benzodiazepine misuse and addiction. But things in your background and environment also play an important role. Some research has shown that risk factors for benzodiazepine misuse may include:
- Female gender
- Younger age (18-25)
- White ethnicity
- Low socioeconomic status
- A history of child abuse or other trauma
- Peer pressure
- Other mental health disorders
Benzodiazepine Addiction Treatment
The most effective treatment for benzodiazepine use disorder is to gradually reduce how much of the drug you use under the supervision of a medical professional. This helps prevent withdrawal symptoms, including seizures. You can do this in a treatment facility or hospital, or at home with the help of your doctor. This tapering-off process may take 10 weeks or more.
Once you're no longer using benzos, you'll need support from your family and friends and, if possible, from a mental health professional, to prevent relapse. In this second, more difficult stage, you may need help finding housing and employment.
No medication has been shown to be effective for treating benzodiazepine use disorder.
The most important step in overcoming benzodiazepine use disorder is to recognize you have a problem and seek help. Signs of a possible misuse include::
- Taking more of the drug than you intended
- Running out of your prescription early
- Being focused on when you can take the next one
- Feeling you can’t live without your pills
- Problems at work, school, or home due to your benzodiazepine use
If you or someone you love has any of these symptoms, contact a doctor or a drug abuse help line. A good place to start is the Substance Abuse and Mental Health Administration (SAMSA) national hotline. Call 800-662-HELP (4357) or visit Findtreatment.gov.
If you're uninsured or under-insured, SAMSA can refer you to state-funded treatment programs, programs that accept Medicare or Medicaid, and those that charge on a sliding scale. If you have health insurance, your insurer can give you a list of providers and facilities covered by your plan.
If you suddenly reduce your dose of benzodiazepines or stop taking them -- even if you've been using them as prescribed by a doctor -- you could have withdrawal symptoms. The longer you've been taking the drugs, the higher your risk for this.
Withdrawal symptoms may include:
- Dizziness or unsteadiness
- Stomach cramps
- Head, face, neck, eye, or tongue pain
- A bad taste in your mouth
- Ringing in your ears
- Sensitivity to light, sound, and smells
- Nausea and vomiting
- Sleep problems or nightmares
- Loss of appetite
- Loss of sex drive
More serious withdrawal symptoms include:
- Confusion or memory loss
- Hallucinations (seeing or hearing things that aren't there)
- Delusions (when you believe things that aren't true) or loss of touch with reality
- A burning feeling on your skin
- A fast heartbeat, high blood pressure, and sweating along with shaking
Symptoms could start a few hours after you last take a short-acting benzodiazepine. With long-acting benzodiazepines, it might take up to 3 weeks to notice withdrawal symptoms.
Benzodiazepines are sedative drugs commonly prescribed for anxiety and sleep disorders. But they can be habit-forming, especially if you take them regularly or for a long time. If you think you or a loved one may have a problem with benzodiazepine misuse, contact a doctor or a drug hotline.
What is benzodiazepine abuse?
Doctors define benzodiazepine abuse as using these drugs for non-medical reasons to get high,
What is the incidence of benzodiazepine abuse?
In a 12-month period between 2014 and 2015, more than 5 million people in the U.S. reported they had misused benzodiazepines. That's out of 30 million adults who used the drugs at all that year.