Safer Using – Benzos

About Benzos

Benzodiazepines or “benzos” are a class of drugs which have sedative, sleep-inducing (hypnotic), anti-anxiety (anxiolytic), muscle relaxant and antiepileptic (anticonvulsant) effects.¹ Benzos act as central nervous system depressants primarily by increasing the activity of the brain’s main inhibitory neurotransmitter, GABA.² Benzos are used medically for the short-term treatment of anxiety, panic attacks, insomnia, seizures and alcohol withdrawal.² They have a high potential to cause dependence when taken regularly and can cause physical and psychological withdrawal effects if stopped suddenly.²

There are many drugs which are classified as benzos, each differing in their effects, duration, and potency.¹ Benzos can have more anti-anxiety (anxiolytic) effects, such as alprazolam, or more sleep-inducing (hypnotic) effects, such as flunitrazepam.¹ Additionally, benzos can be classified according to their duration of effects as follows:³

Short-acting, such as midazolam.
Intermediate-acting, such as alprazolam.
Long-acting, such as diazepam.

Some common benzos are listed below:^1,³

Alprazolam (a.k.a. Xanax, Kalma, Alprax, “bars”, “xans”, “xannys”, “xannies”, “zannies”, “X”) – intermediate-acting anxiolytic.
Diazepam (a.k.a. Valium, Valpam) – long-acting anxiolytic.
Clonazepam (a.k.a. Klonopin, Paxam, Rivotril, “K”, “pin”) – intermediate-acting anxiolytic.
Lorazepam (a.k.a. Ativan) – intermediate-acting anxiolytic.
Midazolam (a.k.a. Hypnovel) – short-acting anxiolytic.
Flunitrazepam (a.k.a. Hypnodorm, Rohypnol, “roofies”, “floonies”) – hypnotic, known for its use as a date-rape drug.

In recent years, novel psychoactive substances have been detected belonging to the benzodiazepine class.⁴ These have been called “novel benzos”, “non-pharmaceutical benzodiazepines”, or “designer benzodiazepines” and are considered “research chemicals” or “designer drugs”.^4,5 While some novel benzos appear to have a similar pharmacology to pharmaceutical benzos, most have not been studied and hence their safety, potency, effects, and toxicity are still unknown.⁴ Novel benzos have been found in fake pills which are sold on the street as Xanax or other benzos.⁴ Five novel benzos were detected in round, white, unmarked tablets circulating in Victoria: bromazolam, clonazolam, etizolam, flualprazolam, and flubromazepam (see https://www.cahma.org.au/article/drug-alert-benzos/).⁵ Clonazolam, flualprazolam and flubromazepam are more potent and last longer than other benzos.⁵ In Victoria, people who consumed as few as one of these tablets required emergency medical attention.⁵

Benzos are active at very small doses and are mostly sold in tablets. This makes it difficult to detect and differentiate between benzos, even with specialised chemistry equipment. Drug checking services like CanTEST do not have the capability to detect benzos on-site in most cases, but some samples are analysed later via mass spectrometry which may confirm the presence and identity of benzos. This information cannot be shared directly with clients of CanTEST, however, an alert may be posted to CanTEST’s social media (https://www.instagram.com/cantestcbr/) if an unexpected or possibly harmful substance is detected.

Benzo Effects

The effects of benzodiazepines can include:¹^,2^,6

Anxiety suppression.
Sedation.
Drowsiness.
Muscle relaxation.
Difficulty forming new memories (anterograde amnesia).
Blackout.
Euphoria in some people.
Loss of balance.
Inability to drive.
Tolerance.
Withdrawal.

The duration of effects depends on the exact benzo and can be up to 10-24 hours for long-acting benzos (see Benzo Dosing below).⁷

These drugs can greatly increase the effect of other depressants, sometimes for days after being taken. People have died after taking a ‘usual’ dose of heroin 24 hours after using diazepam.

Benzo Dosing

Potencies vary widely between benzos, for example alprazolam requires roughly a 10 times smaller dose than diazepam to achieve similar effects.⁷ Dosage guides for some common benzos are listed below.

This following is a rough dosage guide for alprazolam (Xanax/Kalma/Alprax):⁷

LOW DOSE – 0.25-0.5 mg

MEDIUM DOSE – 0.5-1.5 mg

STRONG DOSE – 1.5-2 mg

The effects of alprazolam typically last 5-8 hours.⁷

This following is a rough dosage guide for diazepam (Valium/Valpam):⁷

LOW DOSE – 2.5-5 mg

MEDIUM DOSE – 5-15 mg

STRONG DOSE – 15-30 mg

The effects of diazepam typically last 10-24 hours.⁷

This following is a rough dosage guide for clonazepam (Klonopin/Paxam/Rivotril):⁷

LOW DOSE – 0.25-0.5 mg

MEDIUM DOSE – 0.5-1 mg

STRONG DOSE – 1-2 mg

The effects of clonazepam typically last 8-12 hours.⁷

This following is a rough dosage guide for lorazepam (Ativan):⁷

LOW DOSE – 0.5-1 mg

MEDIUM DOSE – 1-2 mg

STRONG DOSE – 2-4 mg

The effects of lorazepam typically last 4-8 hours.⁷

A tool for converting dosages between benzos can be found here: https://benzo.tripsit.me/.

Benzo Overdose

Death due to a benzo overdose alone is uncommon.⁸ However, combining benzos with other depressants, particularly alcohol and opioids, greatly increases the risk of potentially life-threatening respiratory depression.⁸

The signs of a benzo overdose can include:⁸

Drowsiness.
Slurred speech.
Loss of balance and coordination.
Difficulty forming new memories (anterograde amnesia).
Loss of consciousness.
Slowed breathing.

If you believe someone has overdosed on a benzo and they are awake:

Get them to sit up and keep them awake by asking questions in a loud voice and shaking gently if you feel comfortable.
If they are struggling to regain consciousness, try pinching on the shoulders or rub your knuckles over their chest.
Judge their response and seek medical attention if they deteriorate.
Wait with them until they recover.

If you believe someone has overdosed on a benzo and they are unconscious or not responding:

Seek medical attention as soon as possible.
Place them in the recovery position to keep their airways open and prevent vomit aspiration.
Check breathing periodically.

Benzo Withdrawal

Dependence on benzos can develop quickly and abruptly ceasing to take benzos can cause potentially dangerous withdrawal. The symptoms of benzo withdrawal can include:²

Flu-like symptoms.
Muscle cramps.
Irritability.
Insomnia.
Nightmares.
Perceptual changes.
Depersonalisation or derealisation.

The symptoms of benzo withdrawal can last up to a month depending on the dose and frequency of use.² In a medical setting, people taking benzos typically have their dose lowered slowly until they cease taking the drug (called tapering) to reduce the severity of withdrawal.² If you are experiencing the symptoms of benzo withdrawal and are concerned, consider seeing a non-judgemental health professional such as the GP or nurse at the CAHMA clinic.