Anecdotal reports from some professionals have prompted concerns about young people using prescription benzodiazepines such as Xanax for recreational use.

Border force detections of these drugs have almost doubled in the past five years, further fuelling the worry.

Why are young people seeking benzos?

Benzodiazepines increase the neurotransmitter gamma aminobutyric acid (GABA). GABA reduces activity in the brain, producing feelings of relaxation and sedation.

The effect young people are looking for in using these drugs is a feeling of profound relaxation, reduced inhibition, euphoria and a feeling of detachment from one’s surroundings. Others use them to enhance social experiences or manage the “comedown” from stimulant drugs like MDMA.

Unwanted side effects include drowsiness, dizziness and problems with coordination.

Recreational-use comes with greater risk

When used recreationally, benzodiazepines are usually taken at higher doses than those typically prescribed, so there are even greater risks. These include memory loss, impaired judgement, and risky behaviour, like unsafe sex or driving. Some people report doing things they would not normally do when affected by high doses of benzodiazepines. There are cases of people committing crimes they can’t remember.

When taken at higher doses or combined with other depressant drugs such as alcohol or opioids, they can also cause respiratory depression. In extreme cases, it can lead to unconsciousness and even death.

Using a high dose, as can be common with non-medical use, also increases risk of tolerance and dependence.

How do people get them?

Benzodiazepines for non-medical use are typically either diverted from legitimate prescriptions or purchased from illicit drug markets including online.

Some illegally obtained benzodiazepines look like prescription medicines but are counterfeit pills that may contain fentanyl, nitazenes (both synthetic opioids) or other potent substances which can significantly increase the risk of accidental overdose and death.

Is recreational use growing?

The data we have about non-prescribed benzodiazepine use among young people is patchy and difficult to interpret.

The National Drug Strategy Household Survey 2022–23 estimates around 0.5% of 14 to 17 year olds and 3% of 18 to 24 year olds have used a benzodiazepine for non-medical purposes at least once in the past year.

The Australian Secondary Schools Survey 2022–23 reports that 11% of secondary school students they surveyed had used benzodiazepines in the past year. However they note this figure may include a sizeable proportion of students who were prescribed benzodiazepines but inadvertently reported using them recreationally.

In both surveys, use has remained fairly stable for the past two decades. So only a small percentage of young people have used benzodiazepines without a prescription and it doesn’t seem to be increasing significantly.

Reports of more young people using benzodiazepines recreationally might just reflect greater comfort among young people in talking about drugs and drug problems, which is a positive thing.

Prescribing of benzodiazepines to adolescents or young adults has also declined since 2012.

What can GPs do to reduce the risks?

To reduce the risk of problems, including dependence, benzodiazepines should be prescribed for the shortest duration possible at the lowest effective dose.

It’s important to educate patients that due to the high risk of dependence, benzodiazepines should only be used for a few weeks at most before ceasing.

Patients should also be advised not to take benzodiazepines with other medicines without speaking to a doctor or pharmacist, and not to drink alcohol or take illicit drugs at the same time as using benzodiazepines.

Be aware of counterfeit benzos

Counterfeit benzodiazepines can be purchased illegally online and are increasingly being detected in the community.  People may seek benzodiazepines online not realising that they are purchasing falsified medicines that were not manufactured as legitimate pharmaceuticals. Counterfeit benzodiazepines are more dangerous than pharmaceutical benzodiazepines because there is no quality control and they may contain unexpected and dangerous substances.

In cases where patients report taking benzodiazepines that you did not prescribe,  asking an open-ended question about where the benzodiazepines came from can help bring to light potential safety issues.

Support for underlying conditions

Using benzodiazepines in escalating doses or without a prescription to self-manage stress, anxiety or insomnia may indicate a more serious underlying condition. Psychological therapies such as cognitive behaviour therapy, including mindfulness-based approaches, are very effective in addressing these symptoms and are more effective in the long term. If benzodiazepine dependence has developed, support to taper off benzodiazepines can be provided alongside psychological therapies.

Lifestyle modifications – such as improving exercise, diet and sleep – can also be helpful for patients.

Other medications with a much lower risk of dependence are indicated for the treatment of  anxiety and insomnia.

Specialist services such as  Reconnexions can help provide  counselling and support for people who use benzodiazepines.

Alternatively, CounsellingOnline is a good place for people to get information and referral for treatment of benzodiazepine dependence. The Sleep Health Foundation has some great resources to support those having trouble with sleep.

Note: This article was adapted by the authors for a general practitioner audience. Read the original Conversation article here:  Why do some young people use Xanax recreationally? What are the risks?