Benzodiazepines
{Benzos, Blues, BZDs, Tranks, Z-Bars, Downers}
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Common substitutes and adulterants
Sometimes the drugs we think we are buying turn out to be something very different. Knowing the common substitutes and adulterants is an easy way to protect yourself and your friends.
As benzos are prescription drugs in many countries, most of what is sold originates from pharmaceutical companies and is subsequently diverted to the black market. Unfortunately, high demand has generated illegal unregulated production. This means that dosage cannot be certain and harmful contaminants or cutting agents can be present.
Fentanyl has been found in counterfeit Xanax pills which were the cause of several deaths in the UK. Fentanyl is an extremely strong opioid and its combination with benzos can be fatal due to an enhanced depressant effect of each drug. See the harm reduction box for more information.
‘Etizolam’ has also been sold as a substitute for Xanax. Etizolam is a benzodiazepine analogue, whose effects are similar to benzos. It is not a regulated substance like other benzos and its effects on humans are not fully known.
References
1 Dassanayake, T., Michie, P., Carter, G. and Jones, A. (2011). Effects of Benzodiazepines, Antidepressants and Opioids on Driving. Drug Safety, 34(2), pp.125-156. DOI: 10.2165/11539050-000000000-00000.
2 Canada, H. (2018). Benzodiazepines - Canada.ca.
3 Benzo.org.uk. (2012). Benzodiazepines: How They Work & How to Withdraw.
4 Cooper, S. (1989). Benzodiazepines and appetite: Recent pre-clinical advances and their clinical implications. Human Psychopharmacology: Clinical and Experimental, 4(2), pp.81-89. DOI: 10.1002/hup.470040203.
5 Hojer, J., Baehrendtz, S. and Gustafsson, L. (1989). Benzodiazepine poisoning: experience of 702 admissions to an intensive care unit during a 14-year period. Journal of Internal Medicine, 226(2), pp.117-122. DOI: 10.1111/j.1365-2796.1989.tb01365.x.
6 Partanen, T., Vikatmaa, P., Tukiainen, E., Lepäntalo, M. and Vuola, J. (2009). Outcome after Injections of Crushed Tablets in Intravenous Drug Abusers in the Helsinki University Central Hospital. European Journal of Vascular and Endovascular Surgery, 37(6), pp.704-711. DOI: doi.org/10.1016/j.ejvs.2009.01.016.
7 Starcevic, B. and Sicaja, M. (2007). Dual intoxication with diazepam and amphetamine: This drug interaction probably potentiates myocardial ischemia. Medical Hypotheses, 69(2), pp.377-380. DOI: 10.1016/j.mehy.2006.12.033.
8 Mattila, M.J. and Nuotto E. (1983). Caffeine and theophylline counteract diazepam effects in man. Medical Biology, 61(6), pp.337-43.
9 Emmanouil, D. and Quock, R. (2007). Advances in Understanding the Actions of Nitrous Oxide. Anesthesia Progress, 54(1), pp.9-18. DOI: 10.2344/0003-3006(2007)54[9:AIUTAO]2.0.CO;2.
10 Jones, J., Mogali, S. and Comer, S. (2012). Polydrug abuse: A review of opioid and benzodiazepine combination use. Drug and Alcohol Dependence, 125(1-2), pp.8-18. DOI: 10.1016/j.drugalcdep.2012.07.004.
11 Kroboth P.D., Smith R.B., Stoehr G.P. and Juhl R.P. (1985). Pharmacodynamic evaluation of the benzodiazepine-oral contraceptive interaction. Clinical pharmacology and therapeutics, 38(5), pp.525-32.
12 D'Arcy P.F. (1986). Drug interactions with oral contraceptives. Drug Intelligence & Clinical Pharmacology, 20(5), pp.353-62.
13 Starcevic, B. and Sicaja, M. (2007). Dual intoxication with diazepam and amphetamine: This drug interaction probably potentiates myocardial ischemia. Medical Hypotheses, 69(2), pp.377-380. DOI: 10.1016/j.mehy.2006.12.033.
14 Parle, M. and Dhingra, D. (2003). Ascorbic Acid: a Promising Memory-Enhancer in Mice. Journal of Pharmacological Sciences, 93(2), pp.129-135. DOI: 10.1254/jphs.93.129.
15 Partanen, T., Vikatmaa, P., Tukiainen, E., Lepäntalo, M. and Vuola, J. (2009). Outcome after Injections of Crushed Tablets in Intravenous Drug Abusers in the Helsinki University Central Hospital. European Journal of Vascular and Endovascular Surgery, 37(6), pp.704-711. DOI: 10.1016/j.ejvs.2009.01.016.
16 Chen, J.P., Barron, C., Lin, K.M., and Chung, H. (2002). Prescribing medication for Asians with mental disorders. Western Journal of Medicine, 176(4), pp.271--275.
17 Volkow, N.D., Wang, G.J., Fowler, J.S., Hitzemann, R., Gatley, S.J., Dewey, S.S., Pappas, N. (1998). Enhanced sensitivity to benzodiazepines in active cocaine-abusing subjects: a PET study. American Journal of Psychiatry, 155(2), pp.200-6.
18 Verster, J. and Volkerts, E. (2006). Clinical Pharmacology, Clinical Efficacy, and Behavioral Toxicity of Alprazolam: A Review of the Literature. CNS Drug Reviews, 10(1), pp.45-76. DOI: 10.1111/j.1527-3458.2004.tb00003.x.
19 Haque, W., Watson, D.J., Bryant, S.G. (1990). Death following suspected alprazolam withdrawal seizures: a case report. Texas Medicine, 86(1), pp.44-7.
20 Barker, M., Greenwood, K., Jackson, M. and Crowe, S. (2004). Cognitive Effects of Long-Term Benzodiazepine Use. CNS Drugs, 18(1), pp.37-48. DOI: 10.2165/00023210-200418010-00004.
21 Takada, M., Fujimoto, M. and Hosomi, K. (2016). Association between Benzodiazepine Use and Dementia: Data Mining of Different Medical Databases. International Journal of Medical Sciences, 13(11), pp.825-834. DOI: 10.7150/ijms.16185.
22 Harnod, T., Wang, Y. and Kao, C. (2015). Association Between Benzodiazepine Use and Epilepsy Occurrence. Medicine, 94(37), p.e1571. DOI: 10.1097/md.0000000000001571.
23 Riss, J., Cloyd, J., Gates, J. and Collins, S. (2008). Benzodiazepines in epilepsy: pharmacology and pharmacokinetics. Acta Neurologica Scandinavica, 118(2), pp.69-86. DOI: 10.1111/j.1600-0404.2008.01004.x.
24 Kadoi, C., Hayasaka, S., Tsukamoto, E., Matsumoto, M., Hayasaka, Y. and Nagaki, Y. (2000). Bilateral Angle Closure Glaucoma and Visual Loss Precipitated by Antidepressant and Antianxiety Agents in a Patient with Depression. Ophthalmologica, 214(5), pp.360-361. DOI: 10.1159/000027521.
25 Begleiter, H. and Kissin, B. (1996). The Pharmacology of Alcohol and Alcohol Dependence. New York: Oxford University Press, p.128.
26 Ramsey-Williams, V., Wu, Y. and Rosenberg, H. (1994). Comparison of anticonvulsant tolerance, crosstolerance, and benzodiazepine receptor binding following chronic treatment with diazepam or midazolam. Pharmacology Biochemistry and Behavior, 48(3), pp.765-772. DOI: 10.1016/0091-3057(94)90344-1.
27 Høiseth, G., Andås, H., Bachs, L. and Mørland, J. (2014). Impairment due to amphetamines and benzodiazepines, alone and in combination. Drug and Alcohol Dependence, 145, pp.174-179. DOI: 10.1016/j.drugalcdep.2014.10.013.
Put your brand in front of thousands monthly and support the growth of harm reduction.