Benzodiazepines: Methods of Use and Abuse

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

Benzodiazepine Abuse


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

When used as prescribed, benzodiazepines are ingested in pill form. However, those looking to achieve a more intense or more immediate benzodiazepine high may abuse these drugs by snorting, smoking, or injecting them.8 Misuse of drugs can be very dangerous and may hasten the onset of addiction.8,9

Snorting Xanax or Other 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 Benzodiazepines

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 Benzos

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

Signs of Infection from Shooting Up

If you’re worried you have an infection from injecting drugs, watch for the following signs:21  

  • Fever.
  • Warm, painful, and/or red skin.
  • Pus-filled wounds.
  • Lightheadedness.
  • Dizziness.

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.

Help for Benzodiazepine Abuse 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. Signs of a benzodiazepine use disorder include:22 

  • Not being able to control your use despite the negative consequences.
  • Ignoring personal responsibilities and day-to-day obligations to use benzodiazepines.
  • Trying and failing to cut back or quit.
  • Needing to keep upping your dose to achieve the desired effects.
  • Going through withdrawal when cutting your dose and stopping entirely.

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, you’ll find what you need to get sober and stay that way. Call us at 954-526-5776 to learn more about our programs.


  1. National Institute on Drug Abuse. (2018). Benzodiazepines and Opioids.
  2. Longo, L. & Johnson, B. (2000). Addiction: Part I. Benzodiazepines—Side Effects, Abuse Risk and Alternatives. Am Fam Physician, 61(7), 2121-2128.
  3. Griffin, C. E., 3rd, Kaye, A. M., Bueno, F. R., & Kaye, A. D. (2013). Benzodiazepine pharmacology and central nervous system-mediated effects. The Ochsner journal13(2), 214–223.
  4. National Institute on Drug Abuse. (2018). Research suggests benzodiazepine use is high while use disorder rates are low.
  5. Schmitz A. (2016). Benzodiazepine use, misuse, and abuse: A reviewThe mental health clinician6(3), 120–126.
  6. National Institute on Drug Abuse. (2020). Overdose Death Rates.
  7. Kelly, B. C., Vuolo, M., Pawson, M., Wells, B. E., & Parsons, J. T. (2015). Chasing the bean: prescription drug smoking among socially active youthThe Journal of adolescent health : official publication of the Society for Adolescent Medicine56(6), 632–638.
  8. Guina, J., & Merrill, B. (2018). Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives. Journal of clinical medicine7(2), 17.
  9. Genetic Science Learning Center. (n.d.). Drug Delivery Methods.
  10. Kapoor, M., Winter, T., Lis, L., Georg, G. I., & Siegel, R. A. (2014). Rapid delivery of diazepam from supersaturated solutions prepared using prodrug/enzyme mixtures: toward intranasal treatment of seizure emergenciesThe AAPS journal16(3), 577–585.
  11. Reissig, C. J., Harrison, J. A., Carter, L. P., & Griffiths, R. R. (2015). Inhaled vs. oral alprazolam: subjective, behavioral and cognitive effects, and modestly increased abuse potentialPsychopharmacology232(5), 871–883.
  12. Hogan, R. E., Gidal, B. E., Koplowitz, B., Koplowitz, L. P., Lowenthal, R. E., & Carrazana, E. (2020). Bioavailability and safety of diazepam intranasal solution compared to oral and rectal diazepam in healthy volunteers. Epilepsia, 61(3), 455–464.
  13. Votaw, V. R., Geyer, R., Rieselbach, M. M., & McHugh, R. K. (2019). The epidemiology of benzodiazepine misuse: A systematic reviewDrug and alcohol dependence200, 95–114.
  14. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  15. National Institute on Drug Abuse. (2018). Cocaine Drug Facts.
  16. Houlton JJ, Donaldson AM, Zimmer L, Seiden A. Intranasal drug-induced fungal rhinopharyngitis. Int Forum Allergy Rhinol 2012;22:130–4.
  17. (n.d.). What is hepatitis? 
  18. Government of South Australia. (n.d.). The Risks of Using Drugs.
  19. Pfizer. (2016). Xanax alprazolam tablets, USP.
  20. Semel Institute for Neuroscience and Human Behavior. (n.d.). Potential Complications Of IV Drug Use.
  21. Centers for Disease Control and Prevention. (n.d.). Injecting drugs can give you deadly infections.
  22. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More

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