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AKA: Benzos, tranx, sleepers,
downers. Specific drugs are referred to by their chemical name, brand name,
and some have got slang names. Brand names vary around the world adding to
confusion so for example the drug Diazepam is known by the brand name Valium in
the UK, but is also known internationally by many other trade names including
Mano, Anxol, Placidox and many other.
Name |
Brand |
Slang |
Notes |
ALPRAZOLAM |
Xanax |
Xs, Xans |
Not
an NHS stock drug; Available
in UK on private prescription |
CHLORDIAZEPOXIDE |
Librium |
|
Primarily used in in alcohol detox |
DIAZEPAM |
Valium |
Vallies, blues |
Widely prescribed for
daytime anxiety |
FLUNITRAZEPAM |
Rohypnol |
Rohies, rufies |
Strong associations with drink spiking |
NITRAZEPAM |
Mogadon |
Moggies |
|
TEMAZEPAM |
Normison |
temazies, jellies,
eggs |
Used to be widely
injected |
ETIZOLAM |
|
|
Widely available as
an illicit benzo; |
For
a number of years an additional route for sourcing benzodiazepines was the
overseas prescription market. A number of websites, located outside the UK,
would offer an online “consultation” with a “doctor” and then a “prescription”
would be issued and “benzos” supplied. In practice the variability of the
supplied pills was massive and many of these websites have been shut down.
This approach has been nominally successful with a significant and sustained
drop in benzodiazepine prescribing.
However as the charts below show in the first instance the drop in Benzo
prescribing represented in part simply a shift from one sedating drug to
another. Initially the Z drugs started to get used in place of Benzos. They
were initially not controlled drugs and not perceived to be addictive.
Subsequently
even though benzos and related drugs became harder to get through legitimate
routes, the massive growth of legal benzos as part of the NPS scene and their
subsequent consolidation as an illicit street drug has meant that in some areas
illicit benzos are more of an issue now than leaked prescribed benzos.
Most are distributed as tablets or capsules. A small number of unregulated
compounds are sold as powders. Benzos may also turn up as a cut in other drugs,
especially heroin. Overdoses linked to “strong heroin” or “fentanyl” in heroin
often turn out to be benzos cuts.
A few also come in preparations for injection, such as Valium ampoules, which
command a higher street value.
Different brands of drug will vary from company to company. Tablets will vary
in colour, shape and markings. The
appearance of each drug varies widely so visual pill identification is
difficult.
While it’s no guarantee that pills that
are sold in intact foil strips with UK specific labelling are less likely to be
counterfeit.
Drugs supplied loose, or in overseas packaging are more likely to be
counterfeit.
The mainstay of the street benzodiazepine market has, since the 80s, been diazepam. The most widespread and
popular strength, a 10mg tablet, is often a scored blue tablet. As a result,
people manufacturing tablets to sell as diazepam invariably produce a blue tablet. These
can vary massively in consistency and strength. Some are merely white powders,
dyed blue and compressed into tablets.
Alprazolam (Xanax) has become
increasingly popular in the UK. As it is not widely prescribed on the NHS,
Alprazolam sold in the UK may be from private prescriptions, overseas
pharmacies, or grey-market tablets batched from raw alprazolam powder. These
can vary greatly in strength and consistency. Alprazolam is typically sold as
white, scored bars with XANAX printed on them.
Cost: At a street level, benzodiazepines have
a very low value, typically around 50p per tablet. Ampoules can cost £5 and are
rarely available now. Depending on dose and quantity stronger pills like Xanax
can sell for between £1-5 depending on claimed dose.
Quality: If pills are genuine pharmacy product, quality
is assured. However, it is impossible to correctly identify loose drugs in this
family by eye, let alone assay the strength, so mistakes in strength and name are
frequent amongst those purchasing non-medical products.
With so many imported, fake, unlicensed
and novel products entering the market, the risks with non-pharmacy products
will increase. Products could contain something stronger, weaker or different.
It is possible to send pills to a
service like WEDINOS https://www.wedinos.org/
to find out which drug(s) are present in
a batch. Whilst useful to identify compounds, WEDINOS doesn’t share information
about dose or level of different compounds so is of limited benefit from a harm
reduction or dependency/taper point of view. While the service may indicate a
blue pill contains diazepam and etizolam it won’t say how many milligrams of
each drug are present.
[Source
WEDINOS Annual Report 2021-22]
Methods of
Use: Tablets are designed for oral use,
though some users crush and inject tablets. As diazepam has very poor
solubility in water this is damaging and not very effective. Diazepam itself is
relatively short acting; on ingestion it is metabolised in to a long-acting
metabolite nor-diazepam so the risk is that people need to redose more
frequently if taking via routes other than swallowing. There are some reports
of snorting, especially of novel, unregulated benzodiazepines.
Detection: Immuno-assay (urine
test) kits can detect a range of benzodiazepine metabolites and related
compounds. They are not sensitive for all benzos. This varies according to:
High dose, lower potency, longer acting benzos structurally closer to diazepam
will show up on most tests.
Shorter acting drugs, highly potent drugs and drugs that produce other
metabolites may not show up.
In situations where a person is adamant that they are using a benzo-type drug
but the urine tests negative, it could be that this specific drug at this
specific dose doesn’t show up on this specific urine test. Double checking via
a different brand of test or, ideally, via GC/MS would be a better option.
Some drugs, like GHB and Barbiturates, are GABA agonists (mimics).
Benzodiazepines are not thought to be full GABA mimics. Instead,
benzodiazepines bind to Benzodiazepine Receptors (BZ receptors) and appear to increase
the regulatory effect of GABA. They need GABA, or a GABA-mimic present to work.
Specific benzodiazepines are believed to be more active at different BZ
receptors. This may result in different benzos having greater or lesser
sleep-inducing, muscle relaxing or anxiolytic effects.
Reasons
for Use: Benzodiazepines are still
used medically for a range of conditions including:
Anti-convulsants anti-anxiety (anxiolytic) sleep-inducing (hypnotic)
muscle
relaxant amnesiac alcohol
detoxification
Non-medical use follows similar
patterns, self-medicating for a range of conditions including anxiety and
insomnia. They are also popular as “come-down” drugs following use of
stimulants. The sense of intoxication when used with opiates or alcohol is
greater, so these combinations are widely used. This brings a bigger risk of
overdose.
Benzos can help people not remember or remember without emotion making them
popular choices for managing traumatic memories. They can create a sense of
detachment, depersonalisation or “derealization,” making the real world feel
less present or intrusive.
The sense of calm, detachment, well-being and relaxation from benzos makes them
highly sought after amongst people experiencing negative mental health
symptoms.
Very strong benzos such as Flubromazolam are believed to be 40x the strength of
Diazepam. If a pill contained 1mg of flubromazolam, this would be the
equivalent of 40mg of diazepam (i.e. 4 x 10mg diazepam.)