The document below was submitted to The UK Home Office together with supporting information (A Hidden Epidemic) on 04.07.03, for referral to the Advisory Council on the Misuse of Drugs (ACMD). It was referred to the ACMD by Home Office Minister Caroline Flint MP, for examination by the ACMD Technical Committee,02.10.03.

Request to review the current status of the benzodiazepines

"If any organisation or individual believes that benzodiazepines might be inappropriately classified or scheduled, they are encouraged to make submissions to the Home Office. These would be carefully considered and, if found to represent a credible case, would be referred to the Advisory Council".
Written Answers: reply to question 109012 (3), 29th April Col. 355W From Mr John Grogan MP.

In response to the above, Benzact requests that the Home Office review the current status of the benzodiazepines, in relation to the dangers they now pose as drugs of misuse.

This document highlights some of the evidence regarding benzodiazepines, which we believe constitutes compelling reason to increase their regulation and control by rescheduling, as recommended by the Advisory Council on the Misuse of Drugs in 1998. 1

Contents
Benzodiazepines:
  • Widely misused.
  • Addictive and harder to withdraw from than opiates.
  • Causing increased drug-related deaths.
  • Dangerous to the unborn child.
  • Used to perpetrate crime e.g. "date rape."
  • Cause criminal behaviour.
  • Cause harm to physical and mental health.
  • Create long-term problems in users and their families.
  • A risk factor in HIV, AIDS and hepatitis C.

Misuse of benzodiazepines

  • Up to 90% of illicit drug users use benzodiazepines
  • Diverted prescriptions primary source
  • High rate of use with opiates
  • Used to treat other addictions
  • High rates of use by injecting drug users

Incidence of benzodiazepine misuse
Global benzodiazepine use rose between 1990 and 2000, the highest consumer being Europe. 2
All Benzodiazepines have the potential for abuse with diazepam and flunitrazepam the main benzodiazepines misused worldwide. 3 Rescheduling temazepam reduced prescribing and misuse of temazepam, but misuse of diazepam rose correspondingly.4,5Refs, 1-15

Up to 90% of drug misusers use benzodiazepines in the UK, 6,7 mostly as a secondary drug 5in conjunction with other illicit drugs such as opiates, amphetamines, cocaine, ecstasy, as well as alcohol.8
There are at least 100,000 illicit benzodiazepine users and this is rising.9

Sources of illicit benzodiazepines
The primary source of illicit benzodiazepines are from diverted prescriptions 8 as well as warehouse and pharmacy thefts and forged prescriptions, 3 forming a significant part of the 'grey' drugs market. 10

Benzodiazepine use with opiates
High rates of benzodiazepine use in opiate users are common and associated with increased risk of overdose 11 and worse outcomes overall.12

Used to treat other addictions
Benzodiazepines are used to treat addiction to other drugs such as alcohol and opiates. 8 30-50% of alcoholics use illicit benzodiazepines. 13
Injecting drug users
Up to 49% of injecting drug users at drug misuse centres had injected benzodiazepines. 14 Use of benzodiazepines by injecting drug users is common and associated with increased HIV risk-taking behaviour 15and generally worse outcomes.16 Refs, 1-15


Harmful effects of benzodiazepines

  • Addiction
  • Increased drug-related deaths
  • Danger to the unborn child
  • Damage to health

Addiction
In 1988, the Committee on the Safety of Medicines issued guidelines regarding benzodiazepines and recommended that theyshould not be prescribed for more that 2-4 weeks due to the risk of dependence. 17 Refs,16-29
Dependence on benzodiazepines can occur after 3 weeks continuous use. 18
Alteration in brain chemistry caused by benzodiazepines, becomes hard to reverse over time,19 causing addiction with severe and increasingly protracted withdrawal symptoms.
Benzodiazepines are more difficult to withdraw from than opiates. 20 Withdrawal from benzodiazepines can last for a year or more. 21

Increased drug-related deaths
The Advisory Council on the Misuse of drugs notes that sub-lethal amounts of benzodiazepines and opiates when taken together are responsible for an increase in drug-related deaths. 22 A high incidence of benzodiazepine involvement in drug-related deaths, (particularly with opiates), has been reported in England and Wales, 23 Scotland 24 and Ireland.25
Dangers to the unborn child
90% of women attending drug treatment centres in the UK are of childbearing age. 26 The risks to the children of drug misusers are compounded if their mothers use opiates as well as benzodiazepines; a mixture known to be lethal in adults. 22 Refs,16-29
18% of newborn babies: Benzodiazepines were detected in 18% of newborn babies born at The Princess Royal Maternity hospital, Glasgow between October and November 2000. 27 It is not specified what proportion of the mothers in the study were misusing benzodiazepines.
Figure 1. Selected drugs mentioned in drug-related deaths in Scotland, 1996-2000, (adapted) 24 Key: HRN= Heroin, MNE=Morhine, DZ=Diazepam, TZ=Temazepam.

Category 'X': Benzodiazepines are classified by the United States FDA as category 'D', 28,29 which should not normally be taken during pregnancy or category 'X', 30 which should never be taken during pregnancy.

Refs,16-29    Refs,30-43
  • Dangers at birth Prenatal benzodiazepine exposure can cause toxicity and/or withdrawal effects in the newborn, 31,32 who may need months of treatment, sometimes in special care 33,34,35(opiate-related problems last 2-4 weeks). 35 Increased duration of withdrawal problems have been reported in babies of mothers using benzodiazepines as well as opiates. 34,36
  • Cot death
    An increased incidence of cot death in babies born to opiate users is well established; 37 a risk compounded by the addition of benzodiazepines, which can cause multiple problems including apnoea (stopping breathing). 31,38
  • Effect on parenting
    Cognitive and other health problems due to benzodiazepine use in parents can compromise child-rearing skills. 39
    Research shows an association between adolescent benzodiazepine use/misuse and parental benzodiazepine use. 40,41 Refs,30-43

Damage to health

Physical health
A deterioration in general health associated with benzodiazepine use (particularly long-term), has been reported in both prescribed and illicit users. 42,43,44,45 Refs,30-43  Refs,43-55

Nervous system
Multiple neurological disturbances are common with benzodiazepine use, particularly cognitive impairment. 46 It has been suggested that this may become permanent (particularly with high doses). 47

Long term problems
Symptoms persisting after withdrawal from long-term benzodiazepine use, a 'post withdrawal syndrome', have been reported. 48,49 Refs,43-55
HIV and hepatitis C
Increased rates of Hepatitis C 43 have been reported in injecting drug users who use benzodiazepines, as has increased HIV risk-taking behaviour.15
Injecting dangers
Benzodiazepine injecting can cause venous and arterial damage and carries the risk of amputation.42
Psychological health
Benzodiazepines can cause amnesia, disturbed behaviour, depression, aggression, anxiety and general psychological impairment, 42 causing deterioration in personal care, social interactions and day-to-day function. 50
Suicide risk
Increased suicidal thoughts and tendencies associated with benzodiazepine use have been reported since the early '60s. 51,52Refs,43-55

A danger to society

  • Induce violent behaviour
  • Used in 'date rape'
  • Used to fuel crime
  • High rates of use in arrestees and prisoners
Day-to day function
Deterioration in day-to-day functioning, associated with long-term benzodiazepine use,53 has negative repercussions for users and their families.Refs,43-55   Refs,55-67

Crime

Behavioural disturbance Benzodiazepines can cause violent aggression, memory loss, disinhibition and suggestibility 54 and are implicated in a wide range of criminal behaviour including murder.
Violent crime
Violent crime associated with benzodiazepine use is well documented; for example, in 1980, a woman who stabbed her husband to death was acquitted after the jury heard expert evidence as to the contribution the effects of prescribed diazepam had had on her behaviour. 55 Refs,55-67

Use of benzodiazepines to perpetrate crime

  • Used in "date rape"
    Benzodiazepines are use to disable victims of crime in 'date rape', physical assault, swindling etc., 56 as they induce amnesia, disinhibition and suggestibility. 57 The amnesia caused by benzodiazepines in the victims protects the perpetrator from detection. 58
  • For "Dutch courage"
    Benzodiazepines are used to enhance the mood of the perpetrators of crime as they can induce a sense of invulnerability. 59 Refs, 55-67

Benzodiazepine use in the prison population

Arrestees
Benzodiazepines were detected in 45% of those entering Scottish prisons in 2000, 60and in 14% of arrestees in England and Wales from 1999 to 2000. 61

In Swansea prison, benzodiazepines were the commonest drug detected in new receptions in 1999. 62

Increased aggression and self harm in prison inmates

A direct correlation between benzodiazepine use and increased aggression has been reported frequently reported since the '70s. 63, 64, 65, 66 Refs, 55-67
9 out of 12 suicides in 1999/2000 at HMP Greenock were connected to benzodiazepine or heroin abuse. 67 Refs, 55-67



(C)S.Tuke,
Benzact
Tel: 01670 504155
Email: Benzact.sue@virgin.net
July 2003


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