Diazepam, better known by the trade name Valium, is a prescription medication that belongs to a group of chemically similar sedative and anxiolytic (anti-anxiety) drugs called benzodiazepines (sometimes abbreviated as ‘BZDs’ or ‘benzos’).
Diazepam is used to treat:
- Muscle spasms.
It is also sometimes used to manage the potentially severe symptoms of alcohol withdrawal. In the past, it was also often prescribed to treat insomnia; however, newer, safer hypnotics (sleep-inducing drugs) have largely replaced diazepam for this purpose today.
Origins of Benzodiazepines
Sedatives and tranquilizers have a long history of medicinal and recreational use—starting with alcohol, the original sedative drug. Bromides, chloral hydrate, and paraldehyde were developed in the 1800s, followed by barbiturates and meprobamate in the first half of the 20th century. All of these substances are limited by their high potential for abuse and dependence and their potentially fatal consequences of overdose.
In 1954, Leo Sternbach, a pharmacist and chemist working at the Hoffmann-La Roche pharmaceutical company, was tasked with developing a safer alternative to barbiturates and meprobamate. Over the next few years, Sternbach created about 40 new compounds, but none of them had any effects in animal tests. In 1956, he chemically modified one of these 40 compounds to make it more stable, labeled the resulting white powder Ro 5-0690, and placed it on the shelf where it was forgotten.
By pure chance, the container of Ro 5-0690 was found during a laboratory cleanup a year later and sent to be tested for drug activity. The tests showed it had similar effects to meprobamate, exactly what Sternbach had been trying to discover for 3 years. The compound was renamed chlordiazepoxide, and introduced in the US in 1960 as a new anxiolytic drug under the trade name Librium. This was the world’s first clinically useful BZD.
Valium: the Blockbuster Drug
After the success of Librium, the race was on to create more BZDs for the market. The second successful compound was diazepam, which was introduced in 1963 with the trade name Valium. Diazepam quickly gained immense popularity with doctors and patients. Between 1969 and 1982, Valium was the most prescribed drug in the US, and sales peaked in 1978 with more than 2.3 billion pills sold that year.
Initially, there was a lot of enthusiasm in the medical field for replacing barbiturates with diazepam (and other BZDs). Diazepam has similar sedative and hypnotic effects as barbiturates, but unlike the older drugs, diazepam is a more effective anxiolytic, it is much less likely to result in lethal overdose, and it is said to have a lower potential for abuse and dependence.
During the 1980s and 1990s, however, the use of diazepam and other BZDs became more controversial. Though many psychiatrists continued to view these drugs as a valuable tool for treating anxiety disorders, concerns about overprescribing benzodiazepines, as well as their potential for abuse and dependence mounted.
These concerns, plus the introduction of new generations of hypnotics and anxiolytics, have led to a decline in the popularity of BZDs, particularly diazepam.
Because of its status as the most famous BZD – “Mother’s Little Helper,” as the Rolling Stones called it in their 1966 hit song – many people had heard of Valium and viewed it as a dangerous, overprescribed, habit-forming drug. However, diazepam and related drugs remain among the most widely prescribed psychoactive drugs in the US.
Abuse Potential of Valium
Like alcohol, barbiturates, chloral hydrate and virtually all other sedatives and hypnotics, diazepam increases the effect of the neurotransmitter ?-aminobutyric acid (GABA) in the brain. By binding to GABAA receptors in the central nervous system, Valium decreases, or inhibits, overall neural activity in the brain.
In patients, this increased level of inhibition:
- Reduces feelings of anxiety and panic.
- Relieves painful muscle spasms.
- Helps prevent seizures and convulsions.
However, when taken at high doses or in combination with alcohol or other sedative drugs, it can produce a euphoric high, leading some individuals to abuse it. Although initially most people in the medical community considered BZDs to have a low potential for dependence, many people experience withdrawal symptoms if they take these drugs for an extended period of time—even when taking them as prescribed by a physician. Because of this, doctors usually instruct patients to taper off Valium gradually, rather than to stop taking this drug suddenly.
Relative to other BZDs, Valium is thought to actually have lower potential for dependence. It is therefore used to mitigate withdrawal symptoms from other BZDs and alcohol, including potentially dangerous seizures and convulsions. Once the addicted individual is safely weaned off alcohol or another drug, they can more easily be tapered off Valium.
Who’s Abusing Valium?
The number of admissions to treatment centers for tranquilizer use increased approximately sevenfold in the decade from 2003 to 2012, and admissions for diazepam have increased by a similar amount. This suggests that whatever factors are increasing sedative abuse overall are affecting Valium abuse as well.
Abuse statistics for Valium are mixed, with both positive and negative indications about whether the rates of misuse of this drug are declining or not. Treatment admissions for Valium leveled off between 2012 and 2013, but remain high relative to previous years.
Some important statistics about Valium abuse from the National Survey on Drug Use and Health (NSDUH) include:
- The number of people who reported ever using diazepam for non-medical purposes declined from more than 13 million in 2012 to under 12.5 million in 2013.
- Diazepam is the 3rd most widely abused tranquilizer in the US behind alprazolam (Xanax) and lorazepam (Ativan).
In 2007, the National Center on Addiction and Substance Abuse (CASA) at Columbia University reported that benzos were the most frequently offered prescription drugs on websites selling controlled substances. BZDs were available from 79% of the Internet sites surveyed.
Online Interest in Valium
Using the Google Trends tool to examine the number of Internet searches including the terms “Valium” or “diazepam” reveal that interest in this drug has remained relatively stable over the past decade. The searches using these terms also have a fairly even geographic distribution in the US, though many of the states with the most searches are in the South.
Searches for diazepam have increased slightly over the past several years relative to searches for Valium and may be related to Roche’s recent decision to stop producing and distributing diazepam under the Valium brand. Although Valium and diazepam refer to the exact same substance, patients and abusers accustomed to taking branded Valium sometimes feel trepidation about switching to a generic form of diazepam, and the uptick in searches for diazepam may reflect that anxiety.
Legitimate prescriptions for all benzodiazepines increased 17% between 2006 and 2012. In that same time, the increase in diazepam prescriptions was lower—at only 6%. The population of the US only increased by 1.6% during these years, meaning the number of patients taking these drugs is still increasing. Indeed, it has held its place as the 9th or 10th most prescribed psychiatric medication in the US from 2005 to 2011.
Because diazepam is available as a generic, costs for legal prescriptions are very low, ranging from $9 to $14 for 30 5 mg tablets, or between $0.30 and $0.46 per pill.
The street cost of diazepam varies significantly by region, but has been reported to be between $1 and $5 per 5 mg tablet.
The large profit margin available for selling diazepam to non-medical users provides a strong incentive for legitimate patients to sell their prescriptions.
Furthermore, the profit motive can also induce pharmacists and others involved in the legal supply chain to divert pills to the illicit market, which has resulted in diazepam being one of the most commonly available prescription drugs on the black market.
Valium and the Law
Valium is a legal substance with legitimate medical purpose; however, the Justice Department first designated diazepam as a Schedule IV controlled substance in 1975, which indicates that the government considers this drug to have a real, but relatively low, potential for abuse or dependence. Most other drugs that are designated as Schedule IV substances are also BZDs, like alprazolam and lorazepam, or other tranquilizers such as carisoprodol (Soma).
Doctors, pharmacists, and others involved in the prescribing and distribution of controlled substances such as diazepam are required to keep detailed records for law enforcement purposes. Scientists who use diazepam in their research may also need to obtain a special license to obtain and possess the drug.
The increased levels of prescription drug abuse reported over the last 10 years has led to efforts to further restrict their availability. Tennessee, for example, has enacted rules requiring doctors to:
- Check patients’ drug histories in a statewide database before prescribing drugs such as diazepam.
- Dispense no more than a 30-day supply at one time.
Ireland is also preparing stricter controls on BZDs, including diazepam. These new policies are aimed at limiting the supply for legitimate, necessary purposes, so that less can be diverted to the black market.
Legal Penalties of Using Valium
As a controlled substance, possession of any amount of diazepam without a valid prescription can results in federal felony charges. The penalties for possession start at up to 1 year in prison, a fine of at least $1000, or both for a 1st offense and escalate for subsequent offenses.
Charges of trafficking (possession with intent to distribute) are brought in cases where an individual is found to be in possession of large quantities of the drug (e.g. >100 pills). Such charges for diazepam can result in a fine of $250,000 to $1 million and up to 5 years in prison for a 1st offense.
In addition to federal penalties, many states have enacted their own statutes prohibiting the distribution of diazepam and its possession without a legitimate prescription. These state laws can result in additional legal consequences over and above federal penalties.
The state of Florida, for example, imposes a 2-year driver’s license suspension on anyone convicted of possession of a controlled substance, regardless of whether an automobile was involved in the offense.
How Dangerous Is Valium?Discover how treatment can save your life.
As discussed above, the reason that Leo Sternbach and Hoffmann-La Roche first developed BZDs and diazepam in the 1950s was to create sedative, anxiolytic agents that were safer and more effective than the drugs in use at the time, including barbiturates and meprobamate. By many measures, they succeeded in this effort; diazepam treats anxiety disorders more effectively than barbiturates, has fewer side effects, and is less dangerous to those who overdose on this drug.
However, diazepam still holds real dangers for those who use it, particularly abusers who are not under a doctor’s supervision.
Alarmingly, the majority of abusers combine diazepam with other drugs. Abusers that combine it with other sedating substances – such as alcohol, prescription sleeping pills or painkillers – are at significant risk of overdose. Such ill-advised combinations can produce fatal results.
Whether used alone, or as part of a drug cocktail, the number of emergency room visits resulting from the use of diazepam or other BZDs increased nearly sixfold between 1999 and 2011, confirming the very real danger inherent in using these drugs.
Effects of Valium Overdose
- Slurred speech.
- Respiratory depression.
Finally, although diazepam was initially viewed as having little potential for abuse and dependence, the evidence today clearly shows that taking this drug – as with all other BZDs – can result in dependence and addiction.
Like all other drug addictions, dependence on diazepam can compel individuals to continue taking the drug despite negative consequences on their personal lives and finances, and attempts to stop on their own can cause addicts to suffer from anxiety, panic, or depression, and may even lead to suicide or other dangerous behaviors.
If you have a problem with Valium, help is available. Call to speak to someone confidentially about how to find treatment.