Tranquillisers

 

Medicinal uses

Benzodiazepines are frequently prescribed for the treatment of anxiety and insomnia. They are also used as sedatives before some surgical and medical procedures and for the treatment of some seizure disorders and alcohol withdrawal.

Because they are considered to be safer and more effective, benzodiazepines have largely replaced barbiturates in the treatment of both anxiety and insomnia.

The first benzodiazepine to be produced was chlordiazepoxide, commonly known as Librium. Diazepam (Valium) was the next to be developed and until the early 1980s this was the most widely prescribed tranquillizer in the world. Now newer benzodiazepines such as Lorazepam (Ativan) account for most tranquillizer prescriptions.

 

Use and abuse of tranquillisers

Benzodiazepines are the most commonly prescribed drugs in Britain. Twice as many women take them as men and, where they have been prescribed over a long period of time, many patients have become dependent upon them.

The easy availability of tranquillisers has made them common as drugs of abuse. Some drug abusers take tranquillisers to bring them down after using stimulants such as ecstasy or cocaine. Others take them to 'enhance' the effect of alcohol. They are also used as replacement drugs when an addict's drug of first choice - such as heroin - is not available.

Tranquillisers are not generally injected but Temazepam capsules, known as 'jellies' or 'eggs' became a very popular injected drug among addicts in the late 1980's and early 1990's. Because of this they were banned in 1996, although the tablet form is still available.

 

What effect do they have?

Tranquillisers act as sedatives to lower anxiety and as hypnotics to assist sleep. Many tranquillisers have both effects, often having a sedative effect at low doses and a hypnotic effect at high doses.

A prescribed dose of tranquillisers will usually exert a mild calming effect. Larger doses may cause drowsiness, lethargy dizziness and lack of co-ordination.
Any Benzodiazepine in a high enough dose can act as a hypnotic and induce sleep. The hypnotic effects can last for 3 to 6 hours but this depends on the type of drug used.

If tranquillisers are mixed with other depressant drugs their effect is amplified. For example, drug abusers commonly take tranquillisers with alcohol as tranquillisers exaggerate the effect of drink. Such a combination can cause irrational or aggressive behaviour and is a common cause of injury or death.

 

Consequences of tranquilliser abuse

Consequences for health

A prescribed dose of tranquillisers is generally well tolerated and has a wide margin of safety, so a fatal overdose of these drugs alone is very rare. Nevertheless, overdoses - either accidental or intentional - do happen. While death rarely results from tranquillizer overdose alone, these drugs can be fatal when used in combination with alcohol, heroin or other depressant drugs.

Tranquillisers inhibit mental activity and alertness and impair driving and similar skills that require concentration. Death or injury can easily occur where tranquillisers are mixed with other drugs without appreciation of the dangers. For example, alcohol can 'magnify' the effect of tranquillisers two or threefold. Driving a vehicle would then be very hazardous indeed, even when the individual doses of tranquillisers and alcohol are small.

Tranquillisers can sometimes release aggression by lowering the inhibitions of any user. This can result in violent or irrational behaviour that can pose a risk of injury or death to the user or others.

Dependence

The risk of physical dependence increases if tranquillisers are taken regularly for more than a few months, especially at higher than normal doses. However, problems have been reported after shorter periods of use.

A physician may decide to taper off the dosage of a tranquilliser prescription over a period of time to allow a patient to relinquish tranquillisers without suffering too much in the way of withdrawal. This may be particularly necessary where the patient has been taking tranquillisers for a long period.

Psychological dependence is common in users with a long-term tranquilliser prescription. There may be great fear concerning the thought of living without the drug. After they have stopped using tranquillisers, patients may be confused, irritable and anxious and unable to carry on with their normal routine.

Where tranquillisers are abused by illicit users - i.e. those who have acquired the drug on the black market - the risk of dependence is high as they are likely to take a far higher dosage than is normally prescribed.

Legal consequences

Benzodiazepines (e.g. Temazepam) are classified as Class C drugs under the Misuse of Drugs Act 1971. It is an offence to possess them without a doctor's prescription. It is an offence to supply them to another person. However, if Temazepam is illicitly prepared for injection, then it becomes a Class A drug under the 1971 Act. Penalties for possession and/or supply of Class A drugs are very high.