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Benzodiazepines were chemically produced in 1950’s by Hoffman-La Roche laboratory by chemist Leo Sternbach, becoming one of the most prescribed medicines in the world. Around 16 million are prescribed in the UK alone.

However, modern day benzodiazepines such as Xanax (alprazolam), Ativan (lorazepam), and Klonopin (clonazepam) began their life almost a century ago in Germany, where chemists produced a group of sedatives known as barbiturates. Barbiturates were the first synthetic tranquilizers.

The German pharmaceuticals marketed these drugs under various names such as Secanal, Luminal and Nambutal. The popularity of these drugs rose hugely in America during The Great Depression of the 1930s, when over-the-counter barbiturates helped millions of Americans “take the edge off” by reducing brain activity and depressing the central nervous system. By the time America entered World War 2 in 1941, Americans were consuming more than 1 billion barbiturates per year. During this period, doctors and local pharmacists assured people that these pills were harmless. However, these assurances came from promotional materials distributed by drug producers. The pills did help individuals to sleep and relax however; they too produced tolerance and dependance along with a high risk of overdose. Withdrawals could be horrendous and death may occur. In 1951, the American congress introduced a law that individuals required their doctor’s consent before they could purchase barbiturates. Before the law became introduced, pharmaceutical companies were already looking for the next generation of tranquilizers.

It was at this time that Leo Sterbach, whilst working at the drug company Hoffmann-La Roche in Switzerland, chemically produced the first benzodiazepine Librium which became available in 1960. Librium has the same effects as barbiturates. It depresses the central nervous system, producing a sense of calm. The drug producers and distributors, once again, gave an assurance that Librium was a totally safe breakthrough in modern medicine.

It was discovered that Librium along with other prescribed benzodiazepines had the risks, along with equally dangerous side effects of barbiturates.

The next generation of tranquilizers

In 1958, Hoffmann-La Roche patented a new benzodiazepine called diazepam, which became known as Valium, and quickly took over from the old barbiturates. However, once again, it was discovered that Valium led to dependance along with difficult withdrawals. This led to Hoffmann-La Roche and Wyeth Pharmaceuticals to produce the next generation of tranquilizers, clonazepam (Klonopin) and lorazepam (Ativan). Valium began to be known as the “scary tranquilizer” whilst the new generation of tranquilizers Xanax, Klonopin, and Ativan were described as “good anxiolytics” however, it still remains that all drugs are all equally as dangerous.

In the sixties there were many woman who became reliant on prescribed medication to help them get through the daily routine and anxiety of their lives. The Rolling Stones recorded a record which related to the women’s troubles, called, “Mothers Little Helper”. There were also television adverts for Valium.

Between 1982 until 1994 Dr. Heather Ashton ran a benzodiazepine withdrawal clinic for people who wished to abstain from taking tranquilizers and sleeping tablets. By listening to the experiences of over 300 long suffering individuals Dr. Ashton, learned a lot about the individuals and their problems. Dr. Ashton discovered what the long-term use of benzodiazepines and the withdrawals entailed. Several of the individuals at the clinic reported that they had been prescribed benzos by their GPs for many years, some over 20 years. Many individuals wished to stop as they were becoming unwell, both physically and mentally. Several became depressed, anxious, with irritable bowel, cardiac, or neurological problems. Many of the individuals had hospital checks including full gastrointestinal, cardiological and neurological screening, whereby the results were nearly always negative. The individuals themselves, and not the professionals, discovered that long-term use of benzodiazepines causes many problems. This is why benzodiazepines should only be prescribed short-term (4 weeks).

In 2002, Dr. Heather Ashton revised her “Ashton’s Manual” benzodiazepines guide: ‘Benzodiazepines: How They Work and How to Withdraw’.

Growing concern across the world

Pharmaceutical benzodiazepines, like most medications, are dispensed in blister packs or medication bottles with instructions about dosages and any side effects. These Benzodiazepines are produced in a controlled environment, ensuring that they are the correct dosage and compound. As previously mentioned, depending on the treatment, benzodiazepines should only be prescribed for short term use (4 weeks).

Non-prescribed benzodiazepines (street benzos) are a growing concern across the world, not just Scotland. These benzodiazepines are produced by the thousands anywhere and everywhere. They are produced in an uncontrolled environment whereby they can be contaminated with any substance. Many may be laced with other drugs including nitazenes (opioids) and medetomidine (depressant) along with many others. The benzodiazepine market in Scotland is changing, whereby the strength and contents are highly unpredictable, which increases the risks of overdose. Street benzos are mostly seen as white, yellow or blue round tablets. However, ‘new benzos’ have been emerging including jelly capsules.

There are many effects on individuals who take these ’benzos’, this may include, blurred vision, slow heartbeat, impaired balance and coordination, slurred speech, slow breathing, depression, reduced alertness, sleepiness, short-term memory loss, increased risk behaviour, and cognitive impairment.

Poly-drug use is the leading cause of drug death in Scotland. Poly-drug use is when the individual may take two or more drugs, for example alcohol and benzodiazepines which can cause increased feelings of confidence, nausea, reduced inhibitions, more relaxed, drowsiness, risk of memory loss or confusion, and a greatly increased risk of fatal overdose. Benzodiazepines used along with opioids is also a lethal cocktail.

Unwanted label

Unfortunately, figures have shown that Scotland has the unwanted label of being the drug deaths capital of Europe. In 2014 there were 613 drug related deaths where benzodiazepines were implicated in 121 of these deaths. By 2018 the drug related deaths in Scotland had risen to 1187, with benzodiazepines being implicated in 792 of these deaths. Whilst in 2019 drug related deaths had once again risen to 1264 with benzodiazepines implicated in 888 of these deaths, also 94% of all drug related deaths were linked to people who took more than one substance. 

Benzodiazepines were the second most commonly detected drug when individuals enter prison, after cannabis. There are an estimated 49,113 non-prescribed people using benzodiazepines in Scotland with an estimated 42,892 individuals with problematic benzodiazepine use. There are many different concoctions of benzodiazepines, 4 of the most common used in Scotland are diazepam, etizolam, alprazolam and diclazepam.

There is an antidote for an opioid overdose called naloxone which reverses the effects of the opioid, however, naloxone will not reverse the effects of benzodiazepines, if a person has had an overdose we MUST ADMINISTER NALOXONE, it will still reduce the opioid effect.

As naloxone does not work on benzodiazepines, there is ongoing research projects to discover how we can reverse the effects of benzodiazepines. Flumazenil can be used in hospitals to reverse the effects of a benzodiazepine overdose; however, the antidote has to be administered very slowly as flumazenil can cause seizures. Therefore, flumazenil is given in hospital as this is a controlled environment. There is an ongoing study, The Rufus Trial, which is looking at how flumazenil can be incorporated into saving lives on the street.

Professor Catriona Matheson and colleagues are currently working on a research project, the In-BOAT Trial (Intervention for benzodiazepines use in Opioid Agonist Treatment). This study will involve individuals who are presently being treated with Opioid Agonist Treatment (OAT) and are also taking benzodiazepines. The study will show whether providing a safe supply of prescribed diazepam, with additional support, will help to reduce the use of street benzodiazepines by the participants.

I hope that this information has been helpful. We are always looking for opinions, thoughts, and ideas into how we can reduce the unwanted statistics of being the drug death capital of Europe. I hope that you are trained in the administration of naloxone. If not, why not? You could be saving someone's life. Get trained and always carry your naloxone.