As a teenager I was always anxious, to the point I never felt comfortable in my own skin. But that all changed when I was introduced to diazepam, a benzodiazepine.
I got it through a diverted prescription. The first time I took it, I was 16. It made me feel like I was 10 feet tall, like I was on the pill from Neil Burger’s Limitless movie. The gratification was instant: My acute anxiety was gone. All of a sudden, I had not a care in the world, and was riddled with confidence from head to toe.
Well, after that, every time I was at a friend’s house I would take the first chance I could to look in their parents’ medicine cabinets, rifling through the bottles to find more of the pills we knew as “blueberries.”
Anytime I could get my hands on it, I used anywhere from 50-100 mg of diazepam. But the amazing feeling came at a cost when I ran out. The withdrawal would sometimes leave me shaking and throwing up.
The first time I was admitted to a local, abstinence-based treatment center, I was the youngest person to ever go there, still not 17. I had also been doing a lot of MDMA and other drugs at that time. Altogether, the withdrawal was excruciating. I was in a daze for most of the treatment, but the symptoms included being constipated for two or three weeks, not being able to sleep and just not being myself.
I was there for four weeks, drug-free. But guess what? It didn’t do shit. Sorry for the cliche, but when I left that center I went right back to using. What’s more, I’d learned a thing or two from my fellow-patient buddies, which gave me the confidence to step up my game. I quickly graduated to other classes of drugs, like opioids.
Our local supply mainly consisted of prescription drugs. When I was a teenager, benzodiazepines were everywhere; as I got older, prescription opioids were, if anything, even more available. We obtained opioids and benzos through diverted prescriptions whenever possible in part because, even then, our local heroin supply on the east coast of Canada was a gamble to say the least. Mostly everyone who was wired to opioids got them from people who sold their scripts.
There’s no doubt in my mind that this culture of prescription supply sharing the safest forms of these drugs is partly why our region has considerably fewer overdose deaths compared with some others. Don’t get me wrong; I have overdosed on both opioids and benzos in more recent years, but it was from supplies procured on the toxic unregulated drug market. I’ve also lost a lot of friends to overdoses, even if not to the extent that people have suffered on the west coast.
How can it be right to react to someone’s other drug use, whatever it is, by removing access to the meds that could save their life?
Once I started using opioids, it wasn’t long before I couldn’t handle the withdrawal. I ended up in detox a few times. Finally, my name was called from a year-long waitlist for a local clinic offering methadone. When I first started on this program, back in 2012, I knew I would have to give up using benzos if I wanted to be allowed to keep getting methadone, and honestly, I wasn’t quite sure if I was ready to do that.
Most people who start a medication program are forced to choose between drugs. If people continue to use and give positive urine tests, then some places will kick you out, or at the very least not give you take-home doses. This can often apply even to cannabis use. These policies make no sense, even though combining opioids and benzos does increase risks. How can it be right to react to someone’s other drug use, whatever it is, by removing access to the meds that could save their life?
When I began the program, I was being prescribed benzodiazepines by a different doctor. It always seemed weird to me that instead of just prescribing me methadone and diazepam, the program would leave me to go and “double doctor.”
Foolishly, I told some program workers that I was using diazepam. Very soon, nurses and case managers told me I’d have to give it up if I ever wanted to be “successful” on methadone.
What was I going to do about my acute anxiety, which I’ve been self-medicating for years? Even worse, what if I had to go through benzo withdrawal? It was a frightening prospect. I had just got on medication to relieve me from the opioid withdrawal; now I had to give up medication for my anxiety.
These experiences have always made me wonder about the similarities and differences of opioid and benzodiazepine withdrawal. If people actually knew the feelings, they might not be so quick to judge people who use drugs.
“I would start by saying that they do have a lot in common; both involve a complete inability to feel comfortable in your own skin that feels almost intolerable on a minute-to-minute basis.” Dr. David Frank, a researcher at New York University, told Filter.
Frank conducts research in the behavioral science field on drug use, particularly around medications for opioid use disorder. He is also on methadone himself, and has been open about his experience.
“I’ve gone through opioid withdrawal much more often than I have benzo withdrawal—I’ve only had benzo withdrawal a couple of times,” he said. “I think that benzo withdrawal seems scarier, but it may be because I am less familiar with it.”
“The last time I had benzo withdrawal, I was really concerned about jumping off the fire escape,” he continued. “Had I not been able to get some Xanax, I might have done it.”
I know the exact feeling. Being forced to experience various forms of withdrawal in distressing circumstances—including in jail, for example—undeniably has an impact on people long after the physical symptoms end.
Withdrawing from opioids can be a gruesome experience—like bad flu, but potentially far more intense. The symptoms may include insomnia, hot-and-cold spells, sweats, vomiting, runny nose, dilated pupils and diarrhea. When you first go through it, you often really have no idea what’s happening. Then an old-timer or someone you use with will finally lay it on you: You’re dope-sick.
I’ve been through these brutal experiences more times than you can count on both hands. I guess knowing what to expect makes it less frightening. But I still hate the feeling of forcing myself off it after a binge ends—and the policies of treatment programs that compel you to do so.
After stopping, I found I had literally no idea what was going on.
The most recent time I stopped using drugs was a few months ago. Again, it was due to pressure from a local methadone program. I chose to just go cold turkey. After my past experiences I probably should have known better, but I just wanted it over with.
The benzodiazepine withdrawal was something that I hadn’t felt that intensely in a long time, and pretty horrendous. I’d been using mainly unregulated fentanyl, laced with various types of benzos. I used a lot of it it alongside my prescribed benzos, and the combination had caused me to overdose and black out.
After stopping, I found I had literally no idea what was going on. I was experiencing mental symptoms such as delirium, hallucinations, anxiety and panic attacks. Added to that were physical symptoms like nausea, muscle pain and sweating. The delirium was so bad that I actually ended up at the local emergency department. Luckily I was at the end stages of the cycle by then, so I wasn’t admitted.
It might sound hard to believe when I had experienced it before, but my mental state was such that I didn’t know benzo withdrawal was behind all this until the emergency doctor told me so.
“I don’t like when people say that benzo withdrawal is more ‘mental’ while opioid withdrawal is more ‘physical,’ but there’s probably some truth to that,” Frank said. “You still feel awful when kicking benzos but it’s more like a horrible panic attack, while still feeling exhausted.”
From my personal experiences, I have to agree. As much as the two are similar, when you are withdrawing from opioids everything is crystal clear; with benzodiazepines, the intense mind tricks leave you even more vulnerable.
For anyone wanting to taper from benzodiazepines, seeing a doctor or health care provider is advisable if you can. Loading up on weaker types and lower doses of benzos is something that’s sometimes helped me. Plan on not being able to work, and load up on lots of healthy food. Last but not least, make sure you have loved ones around you!
Our gatekeepers in this system have to do better.
I’m now not using any drugs other than my prescribed methadone. But I have spent the majority of my adult life either using drugs or in withdrawal from them, mostly opioids and benzos.
For much of that time, I’ve had a doctor support me and actually offer me both medications on prescription, but I’m extremely lucky. It was like finding a needle in a haystack. Most doctors won’t issue such prescriptions, especially to people who use banned drugs—often the people who might need them the most.
Unregulated opioids like fentanyl and benzodiazepines like etizolam—combined with whatever’s mixed in with them, thanks to prohibition—continue to spell havoc for many of us who use drugs.
Our gatekeepers in this system have to do better. That goes for the doctors who control access to regulated supply—they need to step up and prescribe people a pharmaceutical alternative to what is on the street. And it goes for treatment providers, who choose whether or not to coerce people into withdrawal that they may not be ready for.
Photograph of prescription benzodiazepines by Matthew Bonn