Benzodiazepines

What are Benzodiazepines?

When prescribed by a medical professional, they are intended to treat stress, anxiety, and sleeping disorders. When abused recreationally, users commonly report feelings of euphoria (a “high”), or when the drug is combined with stimulant type drugs (cocaine, amphetamines, ecstasy) it is used as an aid to ‘come down’. (1)

Irrespective of the use type (legal or illegal) Benzodiazepines are highly addictive. For this reason, usage for medical conditions is generally limited to courses administered over days, or a few weeks at most. Long-term misuse of the drug can cause mental impairment, and result in several negative physical conditions. In addition, persistent use may also result in addiction and the associated problems with withdrawal when users attempt to stop using the drug. (1)

The Benzodiazepine class of drugs in Australia include the following pharmaceutical preparations: Temazepam, Nitrazepam, Diazepam, Oxazepam and Alprazolam. Less common variants include: Bromazepam, Clobazam, Clonazepam, Flunitrazepam, Lorazepam, and Triazolam. (2)

Download the Benzodiazepine Drug Fact Sheet

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Common Street Names

Xannies, Bars, Xanbars, Planks, Bricks, Upjohn, School Bus, K, K-pin, Super Valium, Pin, Benzos, Downers, Nerve Pills, Tranks, V’s, Yellow V’s, Blue V’s, Downers, Tranks, Sleep Aways, Howards, Old Joes (3)

Availability

Benzodiazepines are most commonly prescribed to patients by physicians or other licensed medical practitioners for legitimate health concerns. An unfortunate side effect of this is that some of these prescriptions make their way onto the illicit drug market. For this reason, federal authorities have put various mechanisms in place to discourage “doctor shopping” and on selling. Whilst this has made it harder for illegal users to attain drugs in this fashion, it has led to an increase in the availability of illegally produced benzodiazepines. These illegal versions of the drug can be liquid or powdered benzodiazepines that have been smuggled into the country, cut, and then reformed in a pill press. The look and quality, as well as what other chemicals they have been cut with varies. Beyond these reconstituted versions, there has also been an emergence of “grey market” variants. These drugs have very similar effects on the body after ingestion, however they regularly have quite different chemical compositions to the brand or generic formulations.(4)

The importation of prescription pharmaceuticals is primarily undertaken by individuals for personal use, not for criminal endeavours such as supply and distribution. During the period 2018–19 there were a total of 1,156 pharmaceutical detections at Australian Border facilities, an increase of 98% since 2009–10 (585 detections). The majority (79%) of these detections were for benzodiazepines (912 in 2018–19). (5)

In 2020, the main approach for arranging the purchase of any illicit or non-prescribed drugs by participants of the Drugs Reporting System (EDRS) in the previous 12 months was via social networking applications (such as Facebook, WhatsApp, Snapchat, Grindr, Tinder) (75%), followed by face-to-face (67%). (5)

How Benzodiazepines are used and how to identify them

Benzodiazepines are commonly administered orally and intravenously, though they may also be administered rectally, intranasally, intramuscularly, and smoked. (6) As the drug is both legally and illegally attainable, how it presents is also variable:

• It may be packaged in pill bottles or blister strips if sourced legally, and small plastic sachets, balloons, or household aluminium foil if sourced illegally.
• As there is a wide range of generic and brand formulations of the drug available on the market, the type (capsule or tablet), colour, shape, and size of the pills is equally diverse. This is also true when the drug is in powder and liquid form. (7)
• As the drug may be medically prescribed, or available illegally (reconstituted or “grey market”), it can be difficult to identify specific visual characteristics that distinguish legal from illegal variants.

What are the symptoms of somebody who is under the influence?

The following symptoms are known behaviours associated with systematic drug use. They should not be used as definitive confirmation that a person is drug affected or struggling with substance abuse.

Users may exhibit the following behaviours whilst under the influence of Benzodiazepines:

• Reduced alertness
• Lack of coordination
• Slower reaction times
• Lower inhibitions
• Impulsive behaviour and risk taking (2)
• Severe mood swings and aggression
• Nausea
• Difficulty sleeping and tiredness
• Inability to think critically
• Memory lapses (1)

What are the symptoms of withdrawal?

When it comes to withdrawal, or the effects of ceasing or lowering dosage, some people suffer discomfort for only a few weeks, while others experience ongoing severe symptoms that can persist for many months. Regardless of the length of time involved, the range and severity of symptoms are many, and often intense, so much so that the experience overwhelms all facets of the user’s life. (2)

• anxiousness
• difficulty sleeping and tiredness
• feelings of sensory overload (noise, light, smell, and touch)
• muscle spasms, shaking, and skeletal pain
• headache, dizziness, or migraines
• feelings of hopelessness and generally depressive state
• difficulty concentrating, and memory loss
• loss of appetite, and nausea
• seizures and convulsions may occur where usage has suddenly and completely stopped. (2)

Business Risks

Whilst under the influence of benzodiazepines, many of the symptoms associated with the drugs consumption are likely to cause hazardous behaviours in the user. These actions may not only affect the user personally, but also; the safety of co-workers, a greater risk of damage to plant and equipment, and in the event of an accident, ongoing commercial impacts such as increased insurance premiums, costs associated with injury management, and the potential for costly legal action.

Quick facts about usage

• Benzodiazepines are nervous system depressants commonly prescribed to treat medical conditions such as anxiety, stress, insomnia, epilepsy, and as a sedative prior to a medical procedure, but are also abused non-medically in isolation, and together with other drugs or substances to amplify or counteract the effects of those other drugs or substances. (1)
• In Australia, pharmaceutical drugs that are most often subject to non-medical use are opioids (painkillers/analgesics) and sedatives (sleeping/anti-anxiety medications). Within the “sedatives” category, Benzodiazepines comprise the largest group of drugs in this class. Between 2009 and 2018, the number of deaths where benzodiazepines were present rose by 70%. (8)
• As per the 2019 NDSHS (2019 National Drug Strategy Household Survey), the proportion of people who recently used pharmaceuticals for non-medical purposes was similar for those living in Major cities (4.3%) and Remote and very remote areas (4.8%) (8)
• According to the 2016 NDSHS, 1.6% of Australians aged 14 and over reported having a tranquiliser for non-medical purposes in the past 12 months. (9)
• Benzodiazepines is consistently ranked in the top two drugs present in drug induced deaths for both males and females. This is also the case for both male and female subjects in the age range of 25-55. This statistic confirms that drug abuse can affect employees from any given industry, and at all levels of an organisation. (10)

What does a Benzodiazepine Overdose look like?

When a person uses high or increasing quantities of the drug more frequently, the physical and mental effects of that usage is amplified. When the concentration within a user’s system reaches such a level that the body cannot eliminate the drug fast enough, an overdose occurs. (11)

• blurred or double vision, or temporary loss of sight
• feelings of sadness, confusion, or hopelessness
• sleepiness, dizziness, and an inability to move co-ordinately
• a low body temperature indicated by blueing of the lips and fingernails
• difficulty breathing escalating to the cessation of breathing altogether
• an abnormally high heart rate
• difficulty speaking or slurring of speech
• nausea
• trembling or shaking (11)

What to do in the event of an overdose

If someone looks like they are in trouble and there is a suspicion that they may have been using drugs, it’s very important that they get medical help quickly. A quick response can save their life.

• Call an ambulance by dialling triple zero (000). Ambulance officers are not required to involve the police unless they feel in danger.
• Stay with the person until the ambulance arrives. Find out if anyone at the scene knows CPR in case the person stops breathing.
• Ensure the person has enough air by keeping crowds back and opening windows or taking them outside. Loosen tight clothing.
• If the person is unconscious or wants to lie down, put them in the recovery position. This involves gently rolling them onto their side and slightly tilting their head back. This stops them choking if they vomit and allows them to breath easily.
• Provide ambulance officers with as much information as you can, such as how much of the drug was used, how long ago and any pre-existing medical conditions. If they have taken a drug that came in a packet, give the packet to the ambulance officers.
• If you can’t get a response from someone, don’t assume they’re asleep. Not all overdoses happen quickly and sometimes it can take hours for someone to die. Doing something early could save a life.
• Update your Incident and/or Injury Register with all required details(12)

Detection Window

A Drug Detection Window is the period of time after a drugs ingestion by a user during which a drug or its metabolites remain present in the user’s system and can be detected through various drug testing protocols.

The “period of time” can vary depending on several factors including but not limited to:

• Amount and frequency of use
• Metabolic Rate
• Body Mass
• Age
• Gender
• Overall Health
• Drug Tolerance Level
• Urine Ph Level
• Type of specimen, testing method, and Cut-off Level(13)

Drug	Urine	Sweat	Oral	Blood
Amphetamine	1-3 days	1-4 days	12 hours	2 days
Methamphetamine	1-3 days	1-4 days	1 day	2 days
MDMA	1-3 days	1-4 days	1 day	1 day
THC	1-30 days	1-4 days	12-24 hours	2-3 days
Cocaine	1-3 days	1-4 days	1 day	2 days
Heroin	1-3 days	1-4 days	1 day	2 days

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Help with developing a Workplace Alcohol and Drug Policy

Alcohol and drugs—including medicines prescribed by a doctor or available from a pharmacy—can affect a person’s ability to work safely. Whilst all workers have a personal responsibility to ensure their own health and safety is not compromised in the workplace, or may unduly affect their co-workers, there is also an onus on employers to reduce the risk associated with drug and alcohol impairment where an employee fails in their own duty of care. Among other measures, Employers should develop a Workplace Alcohol and Drug Policy to set forth the principles under which a safe and drug-free working environment is governed. Following are the state-based organisations who can help employers with developing a Workplace Alcohol and Drug Policy.

New South Wales – Download PDF

Queensland – Download PDF

Victoria – Download PDF

Australian Capital Territory – Go to website

South Australia – Australian Capital Territory – Download Doc

Northern Territory – Go to website

Western Australia – Go to website

Tasmania – Download Doc

Works Cited

1. Better Health Channel. Benzodiazepines. Better Health. [Online] October 2020. https://www.betterhealth.vic.gov.au/health/healthyliving/tranquillisers.
2. Beyond Blue. Benzodiazepines. Beyond Blue. [Online] Beyond Blue. [Cited: January 21, 2021.] https://www.beyondblue.org.au/the-facts/anxiety/treatments-for-anxiety/medical-treatments-for-anxiety/benzodiazepines.
3. Addiction Centre. Drug Street Names. Addiction Centre. [Online] Addiction Centre, December 2, 2020. https://www.addictioncenter.com/drugs/drug-street-names/.
4. Nichols, Sam. The Rise, Fall, and Explosive Return of Benzos to Australia. Vice. [Online] Vice, July 28, 2020. [Cited: January 28, 2021.] https://www.vice.com/en/article/m7j5qp/the-rise-fall-benzos-valium-xanax-to-australia.
5. ACIC 2020A. Illicit Drug Data Report 2018-19. Canberra : ACIC, 2019.
6. Bounds, Connor G. and Nelson, Vivian L. Benzodiazepines. NCBI. [Online] STATPEARLS, January 2020. [Cited: January 28, 2021.] https://www.ncbi.nlm.nih.gov/books/NBK470159/.
7. Amin, Nouran. Increasing Misuse of Prescription Drugs. Lab Roots. [Online] Lab Roots, December 18, 2018. [Cited: January 28, 2021.] https://www.labroots.com/trending/drug-discovery-and-development/13570/increasing-misuse-prescription-drugs.
8. AIHW. Alcohol, Tobacco, & Other Drugs in Australia. Canberra : AIHW, 2020.
9. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2016. Canberra : Australian Government, 2017. PHE 214.
10. Australian Bureau of Statistics. Causes of Death, Australia, 2016. Canberra : Australian Bureau of Statistics, 2018.
11. The Treehouse. List Of Commonly Abused Benzodiazepines. The Treehouse. [Online] The Treehouse, May 08, 2020. [Cited: February 02, 2021.] https://www.treehouserehab.org/list-of-benzos/.
12. Alcohol and Drug Foundation. Overdose. Alcohol and Drug Foundation. [Online] February 16, 2017. https://adf.org.au/insights/overdose/.
13. Urine Drug Screening: Practical Gude for Clinicians. Karen E. Moeller, Pharmd, BCPP, Kelly C. Lee. Pharmd, BCPP and Julie C. Kissack. Pharmd, BCPP. 1, s.l. : Mayo Foundation for Medical Education and Research, 2008, Vol. 83. P66-76.
14. Peacock, A. Australian Drug Trends 2019: Key findings from the National Illicit Drug Reporting System (IDRS) Interviews. Sydney : National Drug and Alcohol Research Centre, UNSW, 2019.
15. —. Australian Drug Trends 2020: Key Findings from the National Ecstasy and Related Drugs Reporting System (EDRS) Interviews. Sydney : National Drug and Alcohol Research Centre, UNSW Sydney., 2020.
16. ABS. 1248.0 – Australian Standard Classification of Drugs of Concern, 2011 . Australian Bureau of Staistics. [Online] July 6, 2011. https://www.abs.gov.au/ausstats/abs@.nsf/mf/1248.0.
17. AIHW. Australian burden of disease study: Impact and causes of illness and death in Australia 2015. Canberra : Australian Institute of Health and Welfare, 2019.
18. Alcohol and Drug Foundation. Amphetamine Fact Sheet. Alcohol and Drug Foundation. [Online] January 11, 2021. [Cited: January 19, 2021.] https://cdn.adf.org.au/media/documents/Amphetamine-Fact-Sheet-FINAL.pdf.
19. Better Health. Amphetamines. Better Health . [Online] Victoria State Government, November 2018. [Cited: January 19, 2021.] https://www.betterhealth.vic.gov.au/health/healthyliving/amphetamines.
20. American Addiction Centers. Amphetamine Overdose. American Addiction Centers. [Online] American Addiction Centers, August 19, 2020. [Cited: January 19, 2021.] https://www.recovery.org/amphetamine/overdose/.

Disclaimer

The information on this website is presented by APAC Diagnostic and is intended as an educational and research tool to aid businesses in creating safe and drug free workplaces.

Whilst all due care has been undertaken to ensure the accuracy and currency of the material contained on this website, the information is made available on the understanding that APAC Diagnostic is not providing professional or medical advice on any particular matter.

APAC Diagnostic does not accept any legal liability or responsibility for any injury, loss or damage incurred by use of or reliance on the information provided on this website.

About APAC Diagnostic

APAC Diagnostic sponsors the No Drugs at Work campaign and also offers fully customisable drug testing solutions for your workplace. These include, but are not limited to: Onsite testing, alcohol testing, and drug testing. Our devices are designed to be user friendly and non-invasive.

APAC Diagnostic works with a broad spectrum of businesses in both the private and government sectors. Should you require a quotation on larger commercial quantities of our products or a tailored service solution, please contact our team on +61 2 9986 2252 or via email and we will be pleased to help you in working to create a safe and drug free workplace.