Tranquilizers

Benzodiazepines:  Common Tranquilizers Used in Detoxification

By Bill Landis

Turkeying from gear (heroin) or other strong narcotics and the post-abstinence syndrome that follows can wreak havoc with one’s mental and physical health.  The cycle of eating, sleeping and keeping hydrated can be thoroughly shattered.  The depression and anxiety that narcotics use had dampened and put at bay will return with a roaring force.  During this critical time, various tranquilizers and sedatives can prove to be an invaluable tool in detoxification.

There are certain factors to consider when utilizing sedatives to kick and then stabilize.  At the outset, one should be aware that most of these pills can create their own addiction with repeated use; however, it can then be dealt with medically in a scientifically structured dropdown schedule.  And there are different varieties of narcotics addiction and pan-addiction to consider when this detoxification avenue is approached. 

One scenario involves gear or heavy narcotics users who have only occasionally used downers to boost a high or cover withdrawal between dosages.  Addicts in this category stand to benefit the most from using sedatives to kick, and can receive the maximum benefit from them. 

Addicts who use narcotic tablets in conjunction with downers, and methadone patients who supplement their daily dosage with depressant tablets, are attempting to reproduce a gear high.  These individuals will have to detox from narcotics first, as kicking both opiates and tranquilizers is too much of a shock to the body and can lead to a medical emergency, such as seizures.  It is necessary that opiate detoxification be approached first.  Their tranquilizer intake will should then subsequently be adjusted to a correct medical schedule so stabilization can be achieved before any dropdown is approached.

Benzodiazepines are the family of the safest and most popular tranquilizers.  They relax the large skeletal muscles, and can calm you or make you sleepier depending on the drug and the dosage you take.  Each one has its subtle differences, and inherent advantages and disadvantages. 

Roche Labs in Switzerland invented benzodiazepines in the 1950s.  Researchers noted that the medication made hostile lab monkeys tame.  All benzodiazepines grew out of their mother drug chlordiazepoxide, better known as Librium.  Among the safest of all the benzodiazepines, Librium has a multitude of functions:  it can reduce anxiety; allay panic; induce sleep; relax muscles; has an anti-seizure property; and was one of the earliest medications used to treat the delirium tremens symptoms of alcohol withdrawal.  Librium performs many of the same functions as the other benzodiazepines that are derived from it; in fact, its derivative drugs are designed to emphasize its different functions.

Delirium tremens from alcohol withdrawal is a syndrome with similar muscle spasms, cramping, shaking, sleeplessness and anxiety as a narcotics turkey.  Librium will aid in dampening these symptoms.  It remains effectively used in detox facilities, and can safely be employed in home settings.  Librium comes in several sizes:  25mg, 10mg, and 5mg capsules; and a 15mg tablet.  

The initial recommended dosage for Librium is 25mg four times a day during acute withdrawal.  Doses of 150-200mg per day in the initial two to three day stage of severe turkey are even well tolerated by individuals with large narcotics habits.  It is even possible to sleep through certain rough parts of the turkey on high doses of Librium, as it kicks in fatigue from overactivity by nature.  Once the worst is over, appetite and thirst will be stimulated.

Librium is long acting, meaning that with accumulated doses it can have a half-life of 24 to 100 hours.  This facilitates a slow dropdown from the drug.  The longer the half-life of a benzodiazapine, the easier it is to taper from it, and the less chance of withdrawal symptoms, which range from dysphoria to the biggest risk being seizures.  Librium starts taking effect within about 15 minutes and takes 2 to 3 hours to reach peak plasma levels.

Librium is also available as Librax, a compound designed to treat irritable bowel syndrome, ulcers and nervous stomachs.  Librax combines 5mg of Librium with an atropine derivate.  It’s useful when one wants to drop off a higher dose of Librium in small steps.  Librax also has a legal loophole in the United States, as it is not a controlled substance even though it contains one.  It is pretty abuse-proof, as the atropine content makes it not as sedating as pure Librium, and all that will happen from a large dose is blurry vision, a dry mouth and difficulty urinating.  As Librium and all the benzodiazepines are useful in stimulating appetite, Librax is geared specifically for the stomach and can be helpful as a short to intermediate course of therapy for addicts who are underweight and to settle stomachs that have been through the grinder during a the course of a narcotics habit.

As a rule of thumb, Librium should be used in high doses for only the first week of withdrawal.  Decreasing doses should then be applied as not to create a separate addiction to Librium.  Since it is long acting, if one continues on a high dose of Librium, it keeps accumulating in the body before it is eliminated.  Signs of Librium addiction include mood swings, paradoxical excitement, and exaggerated eye movements.  However, Librium addiction is less difficult to treat than addiction to other benzodiazepines.

Valium (diazepam) is another of the oldest benzodiazepines, and among the best known in the world.    It is used as a long acting sedative, to relax muscles, induce sleep (if taken at bedtime), and allay panic.  It is also used for the delirium tremens withdrawal symptoms for alcoholism, and thus can also dampen the turkey syndrome.  Valium is long acting, with peak effects felt approximately an hour after ingestion, and a half life of about 50 hours.  The usual dosage is four 10mg tablets per day during acute withdrawal, with dosages dropping to three 10mg tablets before gradually tapering off to a safe level, say three 5mg tablets per day the following week.    Valium is available in 10mg, 5mg and 2mg tablets.  There is a time-release 15mg version called Valrelease, which is rarely seen and quite expensive.  Valium will aid sleep, calm nerves and stimulate appetite. 

The downside to Valium is that it has a depressing, weepy quality.  If one continues on a high dose or escalates the dosage in a vain attempt to reproduce the feeling of gear, Valium can create a strong addiction that can result in seizures if abruptly stopped.  A Valium addict sometimes resembles the chronic alcoholic, with the inherent mood swings, and overstimulation followed by depression.  

Xanax (alprazolam) is an extremely popular benzodiazepine, and considered the best by physicians in treating panic attacks. Unlike the older benzodiazepines, Xanax came into vogue in the early 1980s. Xanax works extremely rapidly and starts to peak within 15 minutes of ingestion. Xanax attacks a bunch of underlying conditions that are associated with turkeying. It attacks anxiety first, has sedative and muscle relaxant properties, and can be used to aid sleep. Many people find it preferable to Valium because Xanax has an anti-depressant quality totally dissimilar to the sad mood that Valium is prone to creating. Another strong trait of Xanax is taht it can create an enormous appetitie and thirst. The individual will soon start developing a craving for appealing foods, like Oriental delacies and late night munchies for tasty, sweet treats like Belgian Waffles.

Xanax is available in 0.25mg, 0.5mg, 1mg and 2mg sizes, the latter being known by the slang terms “sticks” or “bars.”  They can be titrated easily, as they have grooves to split into four 0.5 mg doses, and are the most concentrated and rapidly acting.  The downside to Xanax is that it is highly addictive and short acting.  Rebound anxiety after the dose has worn off is a definite problem.  Xanax can cause blackouts in some individuals, especially when used in combination with other drugs or alcohol. 

The half life of Xanax is 12-18 hours, and short acting benzodiazapine withdrawal is difficult to taper from and treat.  Medically, the addictive quality of Xanax is explained as with more frequent the dose, the faster the liver eliminates it, and the more Xanax the body will then need.  The dropdown can be extremely emotional, and the individual will start to face all the sadness that the narcotics had shut off.  Frequently a longer acting tranquilizer like Librium or Valium may be substituted at the last stages of a Xanax taper.

A recommended dosage for Xanax is three of the 2mg “bars” during the initial three to four days of turkeying.  A 2mg Xanax bar has the approximate impact of two fast acting 10mg Valiums.  An intolerant individual will go to sleep shortly after taking a 2mg Xanax bar.  After several days after the turkey subsides, one should attempt to stay at 1mg four times per day, and then decrease it from there, optimally arriving at 0.5mg three to four times per day.  Tolerance to and addiction to Xanax occurs quite rapidly.  It takes a combination of intuition and science to taper off xanax; it is recommended that after one has been taking the medication for some time, to drop off 0.25 to 0.5 mg every three days.  Seizure from rapid dropdown of Xanax is a risk, but can be avoided if the taper schedule the manufacturer’s instructions (available in the Physician’s Desk Reference) are adhered to.

One problem with Xanax is that it feels most like gear out of all the benzodiazepines and many users find that it creates the most euphoria.  This poses special risk for individuals who keep upping the dosage, or who have supplemented their gear or Methadone with Xanax in the past.  Such individuals can wind up taking two or three sticks at a time, which leads to blackouts and drug automatism (a dangerous condition in which the individual forgets how much of the drug they have taken).  Individuals like this, especially if they have damaged livers or conditions like hepatitis, may have to be detoxified from Xanax in a hospital setting.

Serax (Oxazepam) is a predecessor to Xanax and is not as frequently used now.  It has the same fast acting impact as Xanax, but peaks 2 to 3 hours after ingestion, and has a half-life of about 20 hours.  Serax has been employed in psychiatric settings in order to make patients talkative.  It has been variously described as a midpoint between Valium and Librium, or Xanax and Librium.  There have been disconcerting incidents surrounding the use of Serax.  One female patient attending therapy sessions had to be retrieved by her husband at a police station, as she had stripped out of her clothes and ran down the street nude.  Keeping this in mind, and the lack of street sales and infrequent prescribing of Serax, this tranquilizer should be approached with caution.  Serax is available in 10mg, 15mg and 30mg capsules.

Ativan (Lorazepam) is a short acting benzodiazapine that peaks about 2 hours after ingestion with a half-life of about 18 hours.  Ativan is available in 2mg, 1mg and 0.5mg tablets.  A 2mg Ativan is almost a guaranteed knockout two hours after ingestion, making it somewhat helpful for sleep during a turkey.  However, it shuts off the nervous system to the extent that one individual was burned by a hot radiator during an Ativan pass-out.    Methadone addicts who like the hit over the head nod sensation it can create employ Ativan.  Ativan is utilized medically as an intravenous amnesiac during minor surgical procedures, as is Valium.  It has been given intravenously to patients having seizures in detox facilities.  Most sinisterly, it has been given in psychiatric ward settings to calm patients.  Unlike the other benzodiazepines discussed, Ativan has an anti-agitant rather than muscle relaxant property.  As a daytime sedative it is very sad and depressing, with a heavy instance of rebound anxiety.  People have gotten fed up with taking Ativan, cold turkeyed off it, and wound up with a seizure three days later.

Klonopin (Clonazepam, Rivitrol) was invented as an antiseizure muscle relaxant, with sedative, anti-panic and sleep inducing properties. Klonopin takes effect in 20 minutes to 2 hours, depending on the individual, and has a half-life of about 40 hours. Available in 2mg, 1mg and 0.5mg tablets, it is perhaps the strongest benzodiazapine on the market in the United States. Maximum doses for epileptics of Klonopin can reach an enormous 20mg per day, or ten tablets. Klonopin is quite dangerous, and should be used during a detox only on an emergency basis, not as a continuous therapy. It creates a rapid and debilitating addiction, in which the withdrawal syndrome involves panic, sleeplessness, sweating and frequent urination with a strong chemical odor. Klonopin can also de-inhibit anger to the point of fistfights and rages. Singer Stevie Nicks of Fleetwood Mac was given Klonopin at the Betty Ford detox center to treat her freebase cocaine habit. Nicks claims she lost five years of her creative life due to her addiction to Klonopin. Out of all the benzodiazepines Klonopin seems to present the most dangers and problems.

An unorthodox view of both Klonopin and Ativan is that they can be effective when occasionally used as during a taper from gear or narcotic tablets, but at only the lowest medical dose (0.5mg).  When taken around the time the body starts craving a fix, they can aid by exerting their antiseizure/antispasmodic control.  It is possible that certain individuals cannot tolerate the side effects of tablets containing large amounts of these medications.

Certain benzodiazepines specifically deal with sleep.  Restoril (Temazepam) is the current favorite, available in 30mg, 15mg and 7.5mg capsules.  Restoril does help with sleep, although during severe turkey stages two 30mg capsules may be used.  The maximum dosage of 30mg at night is fairly safe, and will create a pleasant relaxed feeling before bedtime.  

Dalmane (Flurazepam) is a precedent to Restoril, available in 15mg and 30mg capsules.  Still used in inpatient and homebrew detox settings, Dalmane tends to create more hangover and has a slightly longer half life than Restoril.  

Both of these medications are not for daytime sedation, as they can cause confusion or lull people into naps.  Another benzodiazapine designed especially for sleep that is available in the United Kingdom and not in the USA and is often given for gear detoxes is Mogodan (Nitrazapam).  Nicky, who operates this Brown Addict site, makes reference to being given Nitrazapam during the week-long, very painful dihydrocodeine gear detox and being given a week’s worth of it afterwards.

Halcion (Trialozam) and Rohypnol are probably the most dangerous sleep inducers in the benzodiazapine family.  The maximum strength of Halcion in the United States is 0.25mg, which was limited by an extensive litigation against the drug’s manufacturer.  Halcion is extremely short acting and tends to create severe blackouts and rebound anxiety.  There is the well known incident of former USA President George Bush Sr. vomiting on himself before passing out at a dinner in Japan after taking Halcion to sleep on the airplane ride from the States.  An HIV positive lawyer told of blackouts after falling asleep where he’d find himself in dangerous areas of New York City.  He said, “if I wanted to get killed, at least I’d like to remember how.”  Both of these drugs should be avoided, whether or not in stages of turkey.

Rohypnol is the infamous “date rape” drug that causes blackouts and loss of memory, especially when combined with alcohol.  It grew in popularity at rave parties and should be avoided.  Before his suicide, grunge star Kurt Cobain overdosed from these pills, as they come in a blister pack and carry the risk of drug automatism.

Benzodiazepine tranquilizers can be a strong aid in detoxing from gear or other strong narcotics.  However, there are many variables.  One must be very wary of which one to employ, as each one has different purposes advantages, each individual responds better to different ones, and some are outwardly risky and dangerous.  Another possibility is that, when stabilizing towards a narcotic-free life, individuals may need to remain on these tranquilizers in order to stabilize mood, treat anxiety that they were self-medicating with gear, and restore correct sleeping and eating patterns.  These medications may be employed over a period of weeks or months.  Optimally the individual will arrive at the lowest effective dosage and should definitely not escalate the dosage in an attempt to mimic a gear habit. 

Last updated: 9 November 2003