In the December, 1982 edition of High Times’ “Abuse Folio” column, David Smith and Rick Seymour write out medical advice from David Smith, M.D concerning Valium.
Valium (diazepam) is the second most commonly prescribed drug in the United States, and is the leading representative of the largest drug group in the world, the benzodiazepines. Valium is widely prescribed for the symptomatic relief of anxiety, insomnia, muscle spasm and is used in the treatment of convulsive disorders and alcohol dependence. Valium has a wide safety ratio and has less overdose potential than other nonbenzodiazepine drugs used for the same purpose, such as the short-acting barbiturates. However, alcohol intensifies the toxic effects of Valium and greatly increases the possibility of overdose and dependence. Individuals with a past or family history of alcoholism may have a psychobiological predisposition to addiction and can develop dependence on Valium at therapeutic doses when taken daily for more than three months. Individuals without such a predisposition, however, can take such a therapeutic dose without developing addiction. This differential response based on biological variability has caused great confusion in the minds of both consumers and physicians relative to the true addicting potential of Valium, and at what dose addiction will take place. Recent research has discovered specific benzodiazepine receptors in the brain, and it is possible that those individuals who are predisposed to addiction have hypersensitive benzodiazepine receptors that facilitate dependence even at therapeutic doses. All benzodiazepines, including the newer drugs being introduced for the relief of anxiety, such as Ativan® (lorezepam), act through the same brain mechanism and have a similar acting potential to Valium. Switching from one benzodiazepine to another will not eliminate addiction but only change the character of addiction. Valium is a long-acting drug, whereas Ativan is a short-acting drug, but the addictive process is similar, just as in the opiate class: Methadone is a long-acting drug and heroin is a short-acting drug, but the addictive process is similar.
Nature and Use
Valium is a synthetic central nervous system depressant and a sedative-hypnotic. This means it has similar qualities and effects to barbiturates and methaqualone. Valium has a variety of therapeutic uses. These include the relief of anxiety, insomnia and muscle spasm. It is also used in treating convulsions and the symptoms of alcohol withdrawal. Valium and other benzodiazepines have receptor sites in the brain that are localized in synaptic contact regions in the cerebral cortex, cerebellum and hippocampus. They work in part by relaxing the large skeletal muscles. In recent years, Valium has gained some notoriety through media accounts of its effects both as a street drug and as a prescribed medication. However, when used judiciously, Valium and the other benzodiazepines have an excellent therapeutic ratio with well-established therapeutic indications, relatively few side effects and less overdose potential than most sedative hypnotics.
Hazards and Liabilities
Valium should not be taken if there is sensitivity to the other benzodiazepines: chlordiazepoxide, oxazepam, flurazepam, prazepam and clonazepam. It should not be taken by anyone with glaucoma as it can increase interior eye pressure. Valium will cross the placental barrier and should not be used during pregnancy. It should never be used in conjunction with alcohol—this combination can be fatal—or with any other sedative-hypnotic substance. There is danger of Valium dependence even at clinical dosages. This danger greatly increases if the user has a personal or family history of alcoholism. We have recommended that physicians with patients on long-term benzodiazepine therapy give these patients periodic “holidays” from the drug at a graded reduction or zero dosage level of approximately five days. This should be done every six months depending on patient needs.
A dangerous result of adverse publicity in recent times has been the abrupt termination of Valium treatment. This should not be done. Abrupt withdrawal, as with other sedative-hypnotics, can cause extensive anxiety and agitation, withdrawal psychosis or life-threatening seizures. Overdoses on Valium are much less frequent than with other sedative-hypnotics, but they do occur. The symptoms are confusion, sleep or sleepiness, lack of response to pain, shallow breathing, lowered blood pressure and coma.
Valium has been used as a drug of deception. In several instances, counterfeit Quaaludes were found to contain high dosages of Valium.
Note: With the termination of Valium treatment, there may be a rebound effect. This is the reemergence of symptoms that the drug was originally prescribed for, such as anxiety or agitation. The re-emergence of original symptoms can be mistaken for withdrawal symptoms.
The need for increasing amounts of Valium to achieve therapeutic effects is a sign of developing tolerance and dependence. If this or any subjective signs of habituation and dependence develop, see a doctor or a drug-treatment facility. Never attempt abrupt withdrawal from Valium after prolonged use, even at therapeutic levels. Gradual reduction or substitution and reduction of a slow-acting sedative-hypnotic, such as phenobarbital, under the care and supervision of a physician, is the safe way. Explore the possibilities of alternative symptom management with your physician if benzodiazepine treatment seems inappropriate, overly extended or if dependency begins to develop. Never mix Valium with alcohol, Quaaludes, short-acting barbiturates or any other sedative-hypnotic. These drugs potentiate the effects of one another, increasing the possibility of a life-threatening overdose far beyond that of any one of these drugs by itself. If an overdose occurs, the patient should be taken to an emergency room or poison center immediately, as severe depression of the cardiorespiratory system can develop. If possible, a sample of the drug taken should be brought along for analysis.
This article is so inaccurate that if offends the senses of educated individuals.
Valium is should never to be prescribed for longer than 2-4 weeks. Not three months.
After that time, the body develops physical dependence, which means If the Valium is abruptly stopped the person will experience the symptoms of withdrawal.
There is a huge difference between physical dependence and addiction. Addiction applies to a set behaviors by individuals seeking them to abuse as they more than likely are with other substances of abuse. Physical dependence mean that the human body has become adjusted to having them in the system and if taken away, withdrawal symptoms occur. Compare this to drinking water and eating. If either is stopped the body will suffer from withdrawal symptoms it relies on to survive.
There are no such things as Benzodiazepines receptors in the brain! Benzodiazepines affect what are called the GABA receptors which, although concentrated, in the human brain and gut, are throughout the human body. GABA is the “feel good” neurotransmitter in humans and Benzodiazepines replace them on the GABA receptors causing these receptor to wither and close up.
Although, it is true that Benzodiazepines, have less overdose potential, The side effects can be severe in individuals due to tolerance and interdose withdrawal. I’ll let the author of this article do the research to educate themself about these.
Giving a patient “periodic medication holidays” every six months would only put that patient through the symptoms of Benzodiazepine Withdrawal Syndrome every 6 months, thus making it more difficult for them each time this occurs.
Abrupt cessation of Valuim could very well cause death besides the seizures, the article mentions. It is one of the two substances that can kill someone if stopped abruptly. The other is alcohol.
The termination does not result in a re-emergence of the original symptoms, only, it intensifies those in most individuals and causes a list of Withdrawal symptoms that are over 100 long.
After reading this article, I can only suggest that the Author do appropriate research before putting into print such misinformation as is displayed in this article.
Hi Barry – sorry for any confusion – this is an article from 1982 reposted specifically to show how much the thinking around drugs has changed over the decades. We do this every friday under the title ‘Flashback Friday’ – please don’t consider these posts updated information. They are very dated and intended only to show how drugs were discussed / enjoyed when there was less science involved.
This article conveys problematic and inaccurate information that has previously resulted in a false sense of safety, and grave harm, among thousands of people who have taken benzodiazepines
exactly as prescribed by their doctors.
First, “dependence” and “addiction/addicting” are different phenomena. Addiction involves problematic substance use behaviors, while physical dependence involves physiological changes from use that will
result in withdrawal symptoms if use is stopped. People can become physically dependent on benzodiazepines and have no knowledge of this until they attempt to stop taking the drug. Alternatively, they can develop various symptoms of drug tolerance that are misdiagnosed as other conditions (and thus treated inappropriately).
Second, physical dependence can occur within 2-3 weeks from taking benzodiazepines daily, as prescribed by a doctor, in people with or without a personal or family history of alcoholism.
Third, “drug holidays” involving a graded reduction over 5 days or an abrupt “zero dosage level” for 5 days can be extremely disabling and dangerous for someone who is physically dependent on
benzodiazepines. Repeated “holiday” withdrawals could also result in “kindling,” a phenomenon in which each subsequent withdrawal can result in more severe withdrawal repercussions, including greater susceptibility to seizures and death.
Fourth, safe benzodiazepine withdrawal after a period of daily/frequent use must be very completed very slowly, over many months (e.g., 6+) or even years, depending on the individual (length
of use, dose, individual factors). Drug treatment facilities are inappropriate for prescribed benzodiazepine withdrawal and can result in further harm.
Fifth, benzodiazepine termination can result in much more than “a rebound effect” and “re-emergence of original symptoms,” especially after long-term use and/or overly rapid cessation. These include cognitive dysfunction, autonomic dysfunction, and more. The “agitation” you reference may actually be akathisia, which can be a very serious complication.
Please learn more about this topic and consider a follow-up article to avoid patient harm.
This article is messy! I couldn’t agree more with those who already commented below. Please, if you are a helping professional or a benzodiazepine sufferer, proceed with caution in reading the above article. The inaccuracies are harmful.
Having a predisposition for an “addiction” like “alcoholism” does not constitute a chemical dependency a benzodiazepine like Valium creates on a physiological level. If an individual is prescribed valium nightly for sleep, or even as needed, then decides to come off the drug with tremendous difficulty due to the systemic changes caused by the benzodiazepine, then they are an addict? To apply an addiction treatment model to a benzodiazepine sufferer is inaccurate, damaging, and ineffective. The chemical dependency a benzodiazepine can cause does not discriminate based on “addictive predispositions.”
“Periodic ‘holidays’ from the drug at a graded reduction of zero dosage level of approximately five days.” 5 days!? Partially due to the drug’s half life, benzodiazepine acute withdrawal may just be STARTING at day 5 when a dosage is gradually lowered! Post acute withdrawal symptoms then can last for up to two years! The ONLY way to safely and effectively taper off a benzodiazepine is SLOWLY!
The “rebound effect” is not the “original” symptom the medication was taken for such as anxiety or agitation but withdrawal. Benzodiazepine withdrawal when not done very, very slowly has the ability to cause an upheaval of every medical symptom imaginable. Telling a patient this is simply anxiety does not validate their discomfort and also ignores their cries for help further shaming an individual and potentially causing long term disabling consequences.
Hopefully pointing out such harmful guidelines will allow helping professionals to better reach their suffering benzodiazepine injured patients. A slow taper model, built on a foundation of compassion, support, validation, patience, and empowerment is the most efficacious route!