Benzodiazepines

Benzodiazepines are a class of substances often used as sedatives and tranquilizers. Although they are some of the most commonly prescribed medications, there is still a risk of overdose and substance use disorder associated with them.

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About benzodiazepines

Benzodiazepines are drugs that slow brain activity. This produces a drowsy or calming effect that can be helpful in treating people with:

  • sleep disorders
  • seizure disorders
  • anxiety disorders, including panic attacks

Benzodiazepines are only legally available by prescription. They come in liquid, tablet or capsule form but are usually given in pill form, for example as:

  • diazepam (Valium)
  • alprazolam (Xanax)
  • lorazepam (Ativan)

Benzodiazepine use can become problematic, which can lead to substance use disorder, overdose and even death. For this reason, benzodiazepines are controlled under Schedule IV of the Controlled Drugs and Substances Act. Activities such as sale, possession and production of benzodiazepines are illegal, unless authorized for medical, scientific or industrial purposes.

Short-term effects of benzodiazepines

The most common short-term side effects of benzodiazepines can include:

  • dizziness
  • confusion
  • drowsiness
  • constipation
  • memory loss
  • slurred speech
  • muscle weakness
  • loss of coordination and balance

Some people can also experience:

  • delusions
  • hallucinations
  • skin reactions
  • sudden anxiety
  • euphoria (a feeling of well-being)
  • restlessness and agitation
  • irritability and aggressiveness

Long-term effects of benzodiazepines

The long-term effects of benzodiazepines can include:

  • physical dependence
  • problems learning or concentrating

If you're prescribed benzodiazepines, talk to your health care provider to make a plan to help reduce your risk of negative side effects. Using benzodiazepines longer than prescribed increases the risk of developing a substance use disorder and dependence from benzodiazepine use.                  

Risks related to benzodiazepine use

Developing tolerance means that, over time, you need more of the drug to get the same effect.
If you stop taking benzodiazepines for a few days and then start again at the same dose, you may increase your chances of an overdose. This is because you lose the tolerance you have built up, after you stop taking it, even if just for a few days.
Mixing benzodiazepines with other depressants such as alcohol and/or opioids can be dangerous. Combining these substances increases the risk of overdose, because they all have sedative properties.

It is still critical to give naloxone, since it temporarily reverses the effects of opioids and can restore breathing, even if you remain unconscious.

While naloxone is not effective in counteracting the effects of benzodiazepines, it is effective against opioid overdoses and it can be safely administered to people who have taken both opioid and non-opioid drugs.

Since benzodiazepines have a sedating effect, if you overdose on a combination of benzodiazepines and opioids, you may remain unconscious for up to several hours even after receiving naloxone.
In all cases of suspected overdose, call 911 for emergency help. Give naloxone if you have it. Remain with the person until emergency help arrives.

Staying at the scene of an overdose is important to help save the life of the person experiencing an overdose. The Good Samaritan Drug Overdose Act gives some legal protection for individuals who witness an overdose and call 911 or their local emergency number for help.

Substance use disorder and withdrawal

Taking benzodiazepines with or without a prescription can lead to physical dependence. When you suddenly stop taking them, or take a much lower dose than usual, withdrawal symptoms may appear.
Symptoms of benzodiazepine withdrawal include:

  • headache
  • muscle pain
  • restlessness
  • stomach pain
  • trouble sleeping

Less common symptoms include:

  • irritability
  • confusion
  • depression
  • extreme anxiety
  • seizures
  • shaking and sweating
  • hallucinations and losing touch with reality

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