Phenazepam is a potent, long-acting benzodiazepine from the former Soviet Union. Although previously uncommon in the western world, Phenazepam abuse and addiction have recently garnered attention as it has been used as a recreational drug.
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Unfortunately, very scant literature exists in English that provides information about this medication which has the capability for severe intoxication, addiction, and even lethality. Therefore, it is imperative to understand the history and brief pharmacology of this unknown drug, the indications of its use, the risks and effects of Phenazepam addiction, abuse, withdrawal, and, what can be done to treat Phenazepam addiction.
Currently, Phenazepam does not have the approval of the United States Food and Drug Administration (FDA) for medical use, meaning that it cannot be marketed as a drug.
More About Benzodiazepines:
What Is Phenazepam?
Phenazepam, sometimes spelled as Fenazepam, is a benzodiazepine medication similar but much more potent than other benzodiazepines such as Diazepam, Oxazepam, and Temazepam. Originally developed in the former Soviet Union during the mid- to late 1970s, it is one of the most frequently prescribed benzodiazepines in Russia and other commonwealth of independent state (CIS) countries for its anxiolytic, anticonvulsant, myorelaxant, and sedating/hypnotic properties.
Being a benzodiazepine, it acts by potentiating or promoting the effects of Gamma-Aminobutyric Acid (GABA), which is an inhibitory neurotransmitter within the central nervous system (CNS). It accomplishes this by increasing the binding affinity of GABA to its receptor. Through potentiating the effects of inhibitory neurotransmitter GABA, it, as well as other benzodiazepine drugs, decrease overall neuronal excitability within the nervous systems. Thus, it can be said that Phenazepam is a central nervous system (CNS) depressant drug that has a variety of dose-dependent actions ranging from sedation, hypnosis, and anticonvulsant effects, to myorelaxation, and anesthesia.
Is Phenazepam Legal In The US?
The Phenazepam legal status within the United States is slightly ambiguous. Currently, it does not have the approval of the United States Food and Drug Administration (FDA) for medical use, meaning that it cannot be marketed as a drug. Neither is it listed as being a controlled substance of any schedule under the United States Controlled Substances Act (CSA) which regulates the manufacturing, importation, possession, use, and distribution of certain substances. Regardless, its sale for human consumption is prohibited by law.
Furthermore, a few states like Louisiana and Arkansas have passed a legislative policy classifying Phenazepam as a dangerous, controlled substance. This legislative policy followed several incidences of individuals exploiting and circumventing the existing policy and selling Phenazepam containing products labeled as “not for human use”.
Phenazepam Dosage Forms, Strength, And Potency
For patients within the United States, obtaining information about Phenazepam dosage is very limited. As mentioned previously, according to the current policy of the US this medication is illegal to obtain nor does it have authorization for medical use. Thus, information about Phenazepam dosage and its strength can only be obtained from medical literature.
It can be administered either orally (PO), intravenously (IV), or intramuscularly (IM) in dosages ranging from 1-5mg.
As for the strength and potency of this medication, one study found that Phenazepam was more potent than Diazepam, and elicited a more pronounced and longer-lasting sedative-hypnotic state.
Phenazepam Side Effects
Phenazepam drug is similar to other benzodiazepine drugs in its spectrum of side effects. Before listing the commonly encountered side effects there are a few characteristics that warrant a mention. Furthermore, some of these characteristics are unique to Phenazepam and set it apart from other benzodiazepine drugs and make it particularly dangerous.
- This drug has a delayed response, meaning that it may take the user 2-3 hours to feel its effects. This invites an inexperienced user to re-dose thinking that the medication did not have an effect, which could prove very dangerous and can lead to acute intoxication/overdose.
- Another unique characteristic is the long Phenazepam half-life of ~15-60h, meaning that after use the user experiences effects for a long period of time. Some case studies even report patients experiencing certain symptoms 5 days or even 3 weeks after ingestion.
- Another factor that individuals should also keep in mind when analyzing the side effects of benzodiazepine drugs is their subjectiveness. This refers to the fact that the user’s personality and expectations about the substance’s effects as well as the setting in which the substance was taken all affect the experienced side effects of Phenazepam and similar benzodiazepine drugs.
- Individuals should be aware that Phenazepam drug side effects are dose-dependent. If its side effects are generalized as “Central nervous system (CNS) depression”, it can be stated that the degree of CNS depression produced is directly related to the dosage of the medication taken.
- Lastly, and perhaps most importantly, individuals should be aware that combining this medication with alcohol and other CNS depressant drugs such as opiates and barbiturates can have a compound effect with patients experiencing severe life-threatening side effects even with minor doses.
Mild to Moderate Side Effects
The following side effects are mostly encountered in those individuals who used this medication in relatively low doses and without combining it with other substances of abuse.
- Anxiolysis and blunted affect with a weakening of attention
- Ataxia and incoordination
- Blurred vision, headache, and dizziness
- Dysarthria and slurred speech
- Muscle weakness and hypotonia
- Impaired judgment and loss of self-control
- Anterograde Amnesia
- Drowsiness, somnolence, and difficulty waking up
Severe Side Effects
The following side effects occur when either very large amounts of this medication are consumed, or more commonly when its use is combined with alcohol and other CNS-depressant drugs.
- Major behavioral disinhibition with hostility and aggression
- Delirium and Psychosis-like behavior
- Stupor
- Coma
- Death
As one can see, the degree and severity of the experienced side effects grow with increasing the dosage of the medication used or when combined with other CNS-depressant drugs. Thus, it is crucial for users to never consume large amounts or combine the use of multiple CNS-depressants.
Indications For Use
In the United State, as per the Food and Drug Association (FDA), there is no authorized medical use for this medication. However, the drug is routinely prescribed in Russia and other Commonwealth of independent state (CIS) countries in much the same way and for the same indications as the more familiar benzodiazepines are in the western world.
Due to the Long Phenazepam Half-Life, Its Use Is Indicated for the Management of the Following Conditions:
- Anxiety and panic attacks
- Increased irritability and emotional lability
- Neurosis and brief reactive psychosis
- Hyperkinesia and various tics
- Epilepsy and Status Epilepticus
- Alcohol withdrawal syndrome
Patients should also remember to not use benzodiazepines, including the Phenazepam pills if they: Have allergies to benzodiazepines; Have neuromuscular diseases; Have narrow-angle glaucoma; Have respiratory disease; Have substance abuse disorders; or are Pregnant.
When a person remains under the influence of these medications for too long, the drugs can cause damage to the individual’s mental and physical health, as well as to their cognitive function.
Phenazepam Addiction
Information regarding specifically Phenazepam abuse or Phenazepam Addiction is scarce and mostly not in English. However, this does not pose much of a problem as addiction to CNS-depressant drugs such as benzodiazepines and barbiturates is often grouped in medical literature under the umbrella term of “Disorders relating to the abuse and addiction of sedative, hypnotic, and anxiolytic drugs”. This is done because motivation, symptomatology, and treatment of these disorders, although unique in certain aspects, share many features. Therefore, if “Phenazepam drug” is generalized as a benzodiazepine, then a discussion about Phenazepam abuse and Phenazepam addiction can be done within the larger scope of benzodiazepine abuse and addiction.
What Makes Phenazepam Abuse and Phenazepam Addiction So Frequent?
It is purported by Kaplan and Sadock that around 6% of individuals have used sedative/hypnotic drugs illicitly. The reasoning why one may abuse or become addicted to such medications can be various:
- Benzodiazepines, like the Phenazepam drug, are prone to the development of tolerance when recreationally or otherwise used for longer than intended. Due to tolerance, users will be forced to take increasing doses of the drug to achieve the same effects and to avoid the development of withdrawal symptoms. This is a primary example of the reasoning behind the development of Phenazepam abuse and Phenazepam addiction.
- Individuals who abuse cocaine may develop Phenazepam addiction as it can reduce symptoms of cocaine withdrawal.
- Individuals who abuse opioids may also be prone to Phenazepam abuse as it can enhance the euphoric effects of opioids.
- Similarly, individuals who abuse stimulant and hallucinogenic drugs can develop an addiction because they may use it to help reduce the anxiety associated with stimulant and hallucinogen use.
Who Is Most at Risk Of Addiction?
As stated above, according to Kaplan and Sadock around 6% of the general population has abused sedative-hypnotic drugs, which would include Phenazepam.
Furthermore, the Following Epidemiologic Data Is Also Available:
- Benzodiazepines as a group tend to be abused by a younger age group, usually younger than 40, with a peak incidence between 26-34 years of age
- There also seems to be a 3:1 female predominance among abusers
- Also, the white-to-black ratio for abuse is 2:1
Thus a typical picture of an individual who may illicitly use this substance could include someone who would take this medication orally to achieve a time-limited relaxation for the evening, to intensify the experience of their sexual activities, or to create mild euphoria. The other picture could include a middle-aged individual with multiple prescriptions for insomnia or anxiety from several physicians.
Signs and Symptoms Of Addiction and Abuse
As it can be seen from the above text, there are various reasons why one may abuse and subsequently become addicted to this medication. Recognizing signs and symptoms of abuse and addiction is of paramount importance as these are the first steps towards getting someone the help they require.
Psychosocial and Behavioral Signs
The psychosocial and behavioral signs that could characterize Phenazepam abuse and addiction would chiefly include behavioral disinhibition manifesting primarily as hostility and anger.
Physical Signs
The physiologic/somatic signs and symptoms would include various manifestations such as somnolence, incoordination, dysarthria, nystagmus, impaired memory, abnormal gait, as well as tachycardia, and hypotension.
Possible Dangers Of Phenazepam Abuse And Addiction
Benzodiazepines are normally only used in short-term treatment, as they have an incredibly high potential for abuse. The recreational abuse of these drugs presents several significant health risks, associated mainly with the duration of the use. When a person remains under the influence of these medications for too long, the drugs can cause damage to the individual’s mental and physical health, as well as to their cognitive function. Two of the most common dangers relating to its abuse and addiction are the development of acute intoxication, sometimes referred to as an overdose, and the development of withdrawal which occurs when an individual stops taking Phenazepam pills abruptly after a period of use.
Overdose
Overdosing on benzodiazepines can be extremely dangerous and result in fatalities, especially if benzodiazepines are combined with other CNS depressants such as alcohol, opioids, barbiturates, first-generation antihistamines, or tricyclic antidepressants.
The dose required to induce an overdose differs depending on a person’s tolerance to the drug and whether the drug was consumed alone or with other CNS depressants.
Possible Symptoms Of Phenazepam Overdose Could Include:
- Lethargy, somnolence, stupor, or coma
- Respiratory depression
- Hypotension with tachycardia
- Muscular hypotonia and weakness
- Gait abnormalities and ataxia
- Slurred speech
- Next-day hangover
Overdose on benzodiazepines can be life-threatening, as such it is crucial to get help as soon as possible. Emergency medical services should immediately be contacted in the case of a suspected benzodiazepine overdose. Meanwhile, it can be helpful to induce vomiting and to prevent the overdosed person from slipping into unconsciousness.
Withdrawal
Withdrawal occurs when its dose is significantly reduced over a short period of time, or if the drug is suddenly discontinued. The severity of the withdrawal syndrome varies depending on the average dose and the duration of use. The onset of withdrawal symptoms for long-acting benzodiazepines, such as this one, occurs with a latency of 5 to 6 days, after which patients will experience various symptoms and signs. These can include:
- Disturbances of mood and cognition: anxiety, apprehension, dysphoria, pessimism, irritability, obsessive rumination, and paranoid ideation
- Disturbances of sleep: insomnia, altered sleep-wake cycle, daytime drowsiness
- Physical signs and symptoms: tachycardia, hypertension, hyperreflexia, muscle tension, agitation, restlessness, tremor, myalgia, arthralgia, nausea, runny nose, sweating, ataxia, tinnitus, seizures
- Perceptual disturbances: hyperacusis, depersonalization, blurred vision, illusions, and hallucinations
Withdrawal can be dangerous and even life-threatening to the individual, and it is of paramount importance that if one wishes to discontinue use they should consult their physician who will help them safely manage their withdrawal symptoms in a controlled environment.
How Long Does Phenazepam Stay In Your System
As previously mentioned Phenazepam half-life is unusually long, between 15-60 hours. The reasoning behind this unusually long Phenazepam half-life is unknown. It is metabolized by the hepatic cytochrome P450 enzymes into various metabolites. Two of which, 5-bromo-(2-chlorophenyl)-2-aminobenzophenone (ABPH) and 6-bromo-(2- chlorophenyl) quinazoline-2-one (QNZ), also appear to have pharmacologic activity themselves.
Today, due to the prevalence of benzodiazepine use and abuse, there exist numerous innovative, highly sensitive, and accurate methods of analyzing benzodiazepines and their metabolites in various biologic samples. The most frequently used biological samples for the analysis of benzodiazepines include blood, urine, and saliva. Furthermore, numerous individual factors affect the duration of benzodiazepines within our systems ranging from the consumed dose, the quality of the product, the mode of consumption, the metabolism of the consumer, the bodyweight of the user, to their overall state of health. The exact duration of how long Phenazepam stays within the saliva, blood, urine, or hair is unknown, as the commonly used immunoassays that test for benzodiazepines in the aforementioned biologic samples are not sensitive towards Phenazepam or its metabolites. However, if data is extrapolated from similar long-acting benzodiazepines such as Diazepam it could be assumed that this medication could be detected in saliva and blood 7-9 days after last use, in urine for several weeks, and in hair follicles for up to 90 days.
Phenazepam Addiction Treatment
As previously mentioned addiction and dependence on Phenazepam pills are not uncommon. As such treatment for it is quite important. Treatment can be broken down into acute management of detoxification followed by chronic management for rehabilitation. The acute management should be done in a hospital setting where the benzodiazepine use can be stabilized at a specific dosage and then gradually tapered down while using adjunct pharmacotherapy with anticonvulsants, blood pressure medications, long-acting sedatives, antipsychotics, and others to keep unwanted side effects of withdrawal at bay. Once detox has been safely achieved, the patient should undergo rehabilitative psychotherapy to maintain long-term abstinence from benzodiazepines and to find new ways of dealing with the triggers and factors that lead them to benzodiazepine abuse in the first place.
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