Flashback Friday: Perspective On Valium And Other Benzodiazepines


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.

First-Aid Plus

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.