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Benzodiazepines

Introduction

Benzodiazepines are a class of sedative/transquilliser drugs used in medical practice to treat anxiety, or induce sleep. The class act on the "benzodiazepine receptor" which regulates the rate of secretion of the inhibitory neurotransmitter GABA (gamma amino butyric acid) in the brain.

The class includes many well-known products, notably diazepam (Valium), temazepam, lorazepam (Ativan), and nitrazepam (mogadon).

Effects and abuse potential

All benzodiazepines have the potential to produce physical or psychological dependence when used in high doses or for a prolonged period of time, with doses of 100mg per day of diazepam or 300mg of chlordiazepoxide liable to cause physical dependence[i]. While it was common for these drugs to be prescribed on a long-term basis between the 1960s and 1980s, the abuse potential has restricted recommended prescribing regimes to a maximum of 2-4 weeks. Short-acting benzodiazepines carry the greatest abuse potential.

Many long-term dependent users of Benzodiazepines were middle-aged or elderly women who acquired their dependency as a result of medical treatment before such dangers were fully-realised.

Among "traditional" groups of drug users, benzodiazepines are rarely the drug of choice, but may be used in a secondary capacity by opiate users when opiates are unavailable, or by stimulant users seeking to "come down". There is a limited market for such drugs, as only a small proportion of those who had tried them reported non-prescription prices.

Side effects of benzodiazepines include Drowsiness and lightheadedness, confusion and ataxia, amnesia may occur, dependence, paradoxical increase in aggression, occasionally headache, vertigo, hypotension, salivation changes, gastrointestinal disturbances, rashes, visual disturbances changes in libido, amnesia, respiratory depression, urinary retention, blood disorders and jaundice; on intravenous injection: pain, thrombophlebitis and rarely apnoea. Driving: drowsiness may affect performance of skilled tasks (e.g. driving). Interactions: effect of alcohol enhanced Alcohol, Neuroleptics, Antidepressants - enhanced sedation

Table 1 - Benzodiazepine Drugs

Drug

Trade name

Duration of action

Equivalent Dose[ii]

Products

Cost/No of tabs

diazepam

Valium (generic)

long (>6hrs)

5mg

2mg tabs, 5mg tabs, 10mg tabs

7p/20, 8p/20, 15p/20

chlordiaze-poxide

Librium (generic)

long

15mg

5mg tabs, 10mg tabs, 25mg tabs

26p/20, 32p/20, 70p/20

lorazepam

Ativan (generic)

short (<4hrs)

0.5mg

1mg tabs, 2.5mg tabs, 4mg amp

24p/20, 36p/20, 40p/1

oxazepam

Seranid (generic)

intermediate

15mg

10mg tabs, 20mg tabs, 30mg tabs

23p/20, 24p/20, 32p/20

flurazepam

Dalmane

intermediate

15mg

15mg caps,

30mg caps

2.92/30, 3.75/30

triazolam

Halcion

very short

150mg

n/a

n/a

nitrazepam

Mogadon (generic)

intermediate

5mg

5mg

16p/20

temazepam

generic

short

10mg

10mg tabs, 20mg tabs

67p/20, 1.13/20

Research on Benzodiazepine Consumption

There is little recent research as to the amounts of benzodiazepines consumed by heavy non-medical drug users. Robson[iii] reported that a large majority of attenders at drug dependency units use benzodiazpines from time to time, 'often in huge doses', and that 'the equivalent of 20-30 times the manufacturers recommended dose is not unusual' due to the development of tolerance.

Our IDMU surveys have shown Benzodiazepine use to be unusual among recreational drug uses, less than 10% of respondents have ever used these drugs, and of those who have used only 5% do so daily. Less than one percent of the overall sample (8% of "ever users) reported buying the drug monthly or more frequently, spending on average a modest 10 to a maximum of 200 per month on these drugs.

Table 2 - IDMU Surveys - Tranquilliser (Benzodiazepine) Use

Usage etc.

1994

1997

1998

1999

2000

2001

2002

2003

2004

2005

Totals

%

Experimental

104

97

113

104

101

25

134

262

213

52

1205

6.06%

Occasional

51

42

59

63

41

10

42

37

47

33

425

2.14%

Regular

17

17

9

24

13

12

38

43

50

35

258

1.30%

Daily

8

7

12

7

4

10

7

4

27

14

100

0.50%

Ex-users

50

45

71

75

63

8

58

60

49

50

529

2.66%

Base

1333

1136

1153

2173

2352

681

2825

2910

2958

2369

19890

100%

Total ever

230

208

264

273

222

65

279

406

386

184

1947

9.79%

% ever used

17.3%

18.3%

22.9%

12.6%

9.4%

9.54%

9.88%

13.9%

13.1%

7.77%

9.79%

-

Rating /10

2.46

3.03

2.89

2.89

2.72

2.53

2.10

3.69

4.62

5.07

3.20

-

No Spending

15

22

19

14

11

5

19

9

36

14

164

0.82%

Avg Spending

7.13

10.50

11.63

9.07

8.63

9.20

10.05

28.50

6.36

10.70

10.08

-

Max Spend

25

50

40

50

40

20

50

200

100

27.50

200

-

Only a handful of respondents who had tried tranquillisers have reported a regular pattern of use or spending on these drugs, the usage of the vast majority falling within prescribing guidelines, with a small minority of excessive users taking up to 10-36 pills a day (2001-2005 data).

Table 3 -Benzodiazepine Consumption Percentiles

Percentile

Tabs per week

Eq. per Day

Spend Month

50% (Median)

5

0.7

5

75%

8

1.1

15

90%

21

3.0

30

95%

30

4.3

50

99%

100

14

100

Max

250

36

200

Base

109

 

53

As the paper surveys have not distinguished between different types of tranquilliser, the IDMU Web-survey allowed more detailed questions to be asked of respondents. Data from the first two years (2004-05) showed Diazepam to be by far the most common tranquilliser reported by drug users, followed by Temazepam and Lorazepam.

Table 4-"Tranquillisers" cited in IDMU Web-Survey 2004/5

Drug

Count

Drug

Count

Diazepam/Valium

104

Mandrax/Quaaludes

2

Temazepam/Jellies

30

Amitriptyline

1

Lorazepam/Ativan

12

Apo-Diazepam

1

Alprazolam/Xanax

7

Aspirin

1

Nitrazepam/Mogadon

7

Barbiturates

1

Hydrocodone/Vicodin

5

Chlorpromazine

1

Zopiclone/Zimovane

5

Dextromethorphan/DXM

1

Clonazepam/Klonopin

4

Dothiepine

1

Benzodiazepines (general)

3

Lexotinil

1

Flunitrazepam/Rohypnol

3

Lithium

1

Oxycodone/Percocet

3

Morphine

1

Chlordiazepoxide/Librium

2

Thorazidine

1

Citalopram/Celexa

2

Triazolam

1

Ketamine/K

2

Base (total n)

860

© IDMU Ltd 2006

[i]              Hoffman FG (1983) A handbook of drug and alcohol abuse. Oxford University Press p125

[ii]              British National Formulary 35 - March 1998

[iii]             Robson PE (1994) Forbidden Drugs. Oxford Medical Publications p119-121

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