Download Sleeping pills and minor tranquillisers

Introduction to
Benzodiazepines
What are Benzodiazepines?
 Benzodiazepines are a family of depressant
or sedative drugs, also known as minor
tranquillisers
 Originally developed by the pharmaceutical
company Roche as a safer alternative to
Barbiturates
 Chlordiazepoxide (Librium) was first
prescribed in the UK in 1960
 Diazepam (Valium) first prescribed in 1963
Benzodiazepines and the brain
 Act on an inhibitory neuro-transmitter gamma
amino butyric acid (GABA)
 GABA regulates and inhibits the release of other
neuro transmitters such as noradrenaline, dopamine
and serotonin
 Without GABA our CNS would be effectively
unregulated and heart rate and body temperature
etc would increase uncontrollably
 Over time, GABA rely on Benzodiazepines for
stimulation – without Benzos, GABA become
inactive
Benzodiazepine effects
All benzodiazepine drugs have the same 5
primary effects in varying degrees
Hypnotic
Amnesic
Anticonvulsant
Anxiolytic
Tends to
cause
sleepiness
Memory
disruption
Reduces
anxiety
Reduces
likelihood of
Seizures
Muscle
Relaxant
Reduces
muscle
tension
and pain
Why are they prescribed?
 Most commonly prescribed for stress and
anxiety
 To help with short term sleep problems
 Sometimes prescribed for sporting injuries
because of their muscle relaxant qualities
 Prescribed as an anti-convulsant for epilepsy
 For alcohol and GHB/GBL withdrawal
Generic and brand names
 Diazepam – Valium
 Chlordiazepoxide – Librium
 Temazepam - Restoril
 Nitrazepam – Mogadon
 Lorazepam – Atavan
 Flunitrazepam – Rohypnol
 Clonazepam – Klonopin
 Alprazolam – Xanax
 Oxazepam – Oxazepam genus
Some street names
Vallies, Blues, Diazies, Mother’s little helper,
Downers, Temazies, Moggies, Bennies, Jellies,
Eggs, Benzos, Benzies, Tranx, Roofies...etc.
Reasons for misuse/illicit use
 To help sleep
 To cope with stress
 To get ‘high’
 Social reasons
 To help with the comedown from other drugs
 In place of other drugs such as heroin
 To increase the effect of other drugs
 Curiosity
 Perception that they’re safer than other drugs
Source: Royal college of Psychiatry available at: http://bjp.rcpsych.org/content/205/5/407
How are they taken?
 Usually swallowed in tablet form
 Oral liquids
 Tablets are sometimes crushed, dissolved in
water and injected
 Some now available in sublingual form
 Injectable liquids – mostly in surgical settings
Side effects
 Drowsiness
 Confusion
 Dizziness
 Blurred Vision
 Lack of coordination
 Memory loss
 Constipation
 Dry mouth
 Difficulty breathing
 Depression
 Paradoxical stimulant effects
Risks
 Overdose
 Tolerance
 Dependency/withdrawal
 Exploitation
 Assault
 STI’s
 Accidents
 Injecting related harms (DVT’s, vein damage,
abscesses etc.)
 Coma and death
Pregnancy and breastfeeding
Benzodiazepines should be avoided if possible during
pregnancy. There is a small risk of physical problems
in the developing baby, such as:
 Cleft palate
 Urinary tract abnormalities
 Heart abnormalities
 Stomach abnormalities
 Dyslexia (difficulty reading and writing)
 Dyspraxia (problems with co-ordination and
movement)
 Autism
 Attention deficit hyperactivity disorder (ADHD)
Ref:http://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/aboutbenzodiazepines/#.WAXcFeArLIU
Pregnancy and breastfeeding
If taken at the end of pregnancy, benzodiazepines
can cause the following problems in new-born babies:
 Drowsiness
 Floppy muscles
 Breathing problems
 Low body temperature
 Withdrawal symptoms including abnormal sleeping
patterns, high-pitched crying, tremors, vomiting
and diarrhoea
Benzodiazepines are present in breast milk, and may
build up in the baby’s body and cause side effects
Ref:http://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/aboutbenzodiazepines/#.WAXcFeArLIU
Tolerance and Withdrawal
 Tolerance can develop quickly (within two
weeks) – higher doses required to get same
effect
Withdrawal symptoms include;
 Increased anxiety
 Sweats and shakes
 Hyper sensitivity
 Muscle aches, joint pain
 Headaches
 Seizures, coma and death
Never tell a dependant user to stop using
Detoxification
 Benzodiazepine use should not be stopped
abruptly
 A process of ‘tapering’ where doses are
reduced over time
 Typically, a reduction of 10% every 1 to 2
weeks down to 20% of original dose, then 5%
every 2-4 weeks
 This process takes months rather than weeks
and for some it can take years. Each detox is
individual
Ref: Benzodiazepine Withdrawal: What to Expect - How to Taper – How to Cope. www.choosehelp.co.uk
Poly drug use
 9 out of 10 deaths where Benzodiazepines are
indicated, include another substance*
 Particularly dangerous when taken in
combination with other respiratory
depressants such as alcohol, heroin,
methadone and GBL
*Office of National Statistics ‘Deaths Related to Drug Poisoning in England and Wales’ 2015
Some Stats
 3,674 drug related deaths reported in 2015*
 366 deaths involving benzodiazepines in
England and Wales in 2015 (highest ever
reported)*
 Diazepam (Valium) accounted for 252 of
these*
 1 in 5 homeless people who reported drug use
reported Benzodiazepine use in the last
month**
*Office of national statistics 2016.
** Homelesslink 2015
Some stats
Of homeless people who reported drug use in
the last month…
 18% men reported Benzo use in the last month
 24% women reported Benzo use in the last month
 Over 25% of people aged 26-45 reported Benzo
use in the last month
 22% rough sleepers reported Benzo use in the last
month
 33% sofa surfing or squatting reported Benzo use
in the last month
Source: Homeless link ‘Homelessness in numbers’ http://www.homeless.org.uk/facts/homelessness-in-numbers/health-needsaudit-explore-data
Alternative drugs/therapies
 Propranolol - Beta blocker
 Anti depressants – e.g. Citalopram
 Alternative therapies – Acupuncture
 Relaxation and meditation
 Psychosocial interventions – e.g. CBT
 Mutual aid (NA, SMART recovery)
Harm minimisation
 Avoid respiratory depressants such as alcohol,




heroin, methadone, GHB/GBL, as these
interact increasing sedation and risk of fatal
overdose
Avoid mixing benzos (they can react with
each other)
Avoid using alone
Refer injectors to needle exchange services
Ask clients about benzos specifically when
assessing
The Law
 Benzodiazepines are controlled under the
Misuse of Drugs Act 1971 and are categorised
as Class C
 Unauthorised possession (i.e. without a
prescription) could result in a 2 year prison
sentence and an unlimited fine
 Supplying, which includes giving
Benzodiazepines to friends, could mean up to
14 years in prison and an unlimited fine
Questions and discussion
References and links
 Benzodiazepine Withdrawal: What to Expect - How to Taper – How to
Cope. Available at
http://www.choosehelp.co.uk/topics/detox/sedative-anti-convulsantdetox-ativan-ambient-benzodiazepines#royal-college-ofpsychiatrists-benzodiazepines
 Deaths related to drug poisoning in England and Wales (Office of
National Statistics), 2016. Available at
http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeaths
andmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglan
dandwales/2015registrations#diazepam-deaths-remain-stable-in2015
 Health Survey for England (HSE), 2015. Available at
http://nesstar.ukdataservice.ac.uk/webview/
 Homelessness in numbers (Homeless link), 2015. Available at
http://www.homeless.org.uk/facts/homelessness-in-numbers/healthneeds-audit-explore-data
References and links
 Mind ‘Sleeping pills and minor tranquillisers’ Available at:
www.mind.org.uk/information-support/drugs-and-treatments/sleepingpills-and-minor-tranquillisers/about-benzodiazepines/#.WAXcFeArLIU
 Royal College of Psychiatry (2014) ‘Misuse of benzodiazepines and Z-
drugs in the UK’ Available at:
http://bjp.rcpsych.org/content/205/5/407
Links:
 Benzo guide – information and advice
http://www.benzoguide.co.uk/basic-harm-reduction.aspx
 Benzo.org.uk – information, advice and links
http://www.benzo.org.uk/index.htm
 Mind in Camden – REST - Benzo specific service
http://www.mindincamden.org.uk/resources/articles/minor-tranx
 Blenheim – Information and drug and alcohol services
http://blenheimcdp.org.uk
Thank you