Methods of Benzodiazepine Misuse: Snorting, Smoking, and Injecting

Benzodiazepine misuse is leading to an increased number of overdose-related deaths and emergency department visits, according to a study published in Drug and Alcohol Dependence. Some of this trend is attributable to the methods that people misuse benzos.

This article will explain the risks of the different methods of benzodiazepine misuse, and how to get help for yourself or a loved one if you’re struggling with dependence or addiction.

What Are Benzodiazepines?

Benzodiazepines are prescription sedatives that are commonly prescribed for the short-term management of anxiety. Benzodiazepines increase the efficiency of GABA, a neurotransmitter that inhibits activity in the brain to produce a feeling of sedation and calm.¹

Benzodiazepines include but are not limited to the following medications:²

• Alprazolam (Xanax).
• Lorazepam (Ativan).
• Clonazepam (Klonopin).
• Triazolam (Halcion).
• Diazepam (Valium).

Benzodiazepines can be very effective for issues like anxiety, muscle spasms, and even epilepsy due to their sedative, hypnotic, anticonvulsant and anxiolytic action in the brain.³ However, benzodiazepines have risks, ranging from mild (e.g., drowsiness) to serious (e.g., respiratory depression) and they are intended only for short-term and intermittent use.^2,3

How Are Benzodiazepines Misused?

While benzodiazepines are safe when used as prescribed and monitored by a physician, misuse as well as long-term use can result in an addiction to benzodiazepines, or sedative use disorder.² Benzodiazepines are often misused in combination with opioids or alcohol, which can be very dangerous, as all of these drugs have an additive effect on one another.^4,5 This can lead to overdose and result in a potentially fatal depression of life-sustaining functions such as breathing. In 2018, 85% of the 10,724 benzodiazepine overdose deaths involved an opioid.⁶ Benzodiazepines may also be misused in an effort to combat the unwanted effects of stimulants, such as cocaine.^5,7

Snorting Benzodiazepines

Those who are abusing benzodiazepines to get high may resort to taking it other ways in an attempt to intensify the effects or to feel them more quickly. However, this attempt may be misguided. There is little to no evidence to support that snorting a crushed benzodiazepine pill actually produces any additional benefit.^10–12

One small study by a pharmaceutical company was able to show a modest speed of onset of certain rewarding effects  in intranasal delivery of Xanax.¹² Another small study found intranasal delivery of Valium was delivered faster through a nasal spray but resulted in lower relative bioavailabity of the drug, which may actually decrease the drug’s rewarding effects.¹¹ However, both these studies used special preparations and delivery methods to facilitate absorption and maximize effectiveness via nasal delivery; it is unlikely that crushing and snorting a pill would compare as favorably.^11,12

In the case that snorting a benzo does produce more rapid or potent effects, the potential for abuse, drug liking, and addiction may be increased.^9,11

The contents of a benzodiazepine pill or tablet were not manufactured for safe intranasal use. Unfortunately, snorting is the second most common way these drugs are abused.¹³  Over time, the deposition of the snorted contents in the airways and lungs can lead to adverse reactions such as local inflammation, nasal mucosal irritation, nose bleeds, frequent runny nose, loss of smell, ulceration, and increased airway reactivity.^14,15

Snorting prescription pills has been shown to cause various forms of nasal damage (including holes in the nasal septum) and infection, such as Staphylococcus aureus (“staph infection”).¹⁶ Intranasal use is also associated with a higher risk of overdose.⁸

Snorting benzodiazepines may also lead to the transmission of Hepatitis C (HCV) via shared straws or other implements used for snorting the crushed-up pills.¹⁷

Risks of Smoking Benzos

Smoking is another way that people attempting to get a greater high will abuse a drug.

Smoking prescription drugs, including benzodiazepines, is a common drug tend among youth who are socially active. Smoking represents an escalation of drug use that is concerning because it is often linked to dependence and other drug-related problems. ⁷

Moreover, abusing a substance recreationally by smoking it may result in health risks that include:¹⁸

• Chronic cough.
• Shortness of breath.
• Wheezing.
• Chronic bronchitis.

Risks of Injecting Benzodiazepines

Injection of benzodiazepines is far less common than oral or intranasal administration, mainly because Xanax, and most other benzodiazepines with the exception of midazalom (Versed), are not water-soluble and are difficult to prepare into an injectable solution.¹⁹ Those with severe patterns of substance use and substance use disorders are more likely to abuse these medications in this way.¹³

Among those who inject drugs, polysubstance abuse involving opioids is very common, as benzos are often sought to enhance the opioid high.¹³ The benzo/opioid combination is a very dangerous one due to the potential for severe respiratory depression, coma, and death.^5,13 Injection use increases the risk of accidental overdose.¹³

Overdose isn’t the only risk of injecting drugs. Any injection drug abuse has the potential to create a myriad of health problems for the user. Injecting drugs may lead to:^13,18,20,21

• Bacterial infections.
• Abscesses.
• Infection of the heart lining (endocarditis).
• Damage to the veins.
• Scarring.
• Transmission of bloodborne diseases such as HIV or HCV.
• Stroke.

How to Recognize Benzodiazepine Addiction

While a substance use disorder (e.g., addiction) can only be diagnosed by a qualified healthcare professional, knowing what the signs of benzodiazepine addiction can be helpful. If you recognize any of these signs or symptoms in yourself or a loved one it may be time to get professional help.²² 

• Taking more of a benzo medication or taking it for a longer time than originally intended.
• Being unable to cut down or control your benzodiazepine use despite multiple attempts and an continuing desire to stop.
• Spending increasing amounts of time obtaining, using, and recovering from benzo use.
• Having cravings or very strong desires to use benzodiazepine medications.
• Having issues at work, school, or home due to benzo use.
• Using benzodiazepines despite the knowledge that it consistently causes or worsens social, family, or other relational problems.
• Giving up activities you previously enjoyed due to use.
• Repeated benzo use in physically dangerous situations, such as while driving a car.
• Continuing to use benzos despite knowing that it has contributed to or made worse physical or psychological problems.
• Developing tolerance to benzodiazepine medications (e.g., requiring more of them to achieve the same effect as before).
• Experiencing withdrawal symptoms when use is abruptly cut back or suddenly stopped.

Help for Benzodiazepine Misuse and Addiction

Benzodiazepines are meant to be used in pill/capsule/tablet form and are intended to be used on a short-term basis. If you or someone you love is taking these drugs in ways other than prescribed or for longer periods than intended, you may have a problem that needs treatment.

If you feel your benzodiazepine use has gotten out of your control, we can help. Recovery First offers a range of treatments to help you every step of the way. Your care begins with medical detoxification to keep you safe during the potentially life-threatening withdrawal from benzodiazepines and may move through multiple phases including inpatient rehab and outpatient therapy. In our comprehensive program for benzo addiction treatment, you’ll find what you need to get sober and stay that way.