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.

So why do young people use them, and how do the harms differ to those used as prescribed by a doctor?

What are benzodiazepines?

You might know this large group of drugs by their trade names. Valium (diazepam), Xanax (alprazolam), Normison (temazepam) and Rohypnol (flunitrazepam) are just a few examples. Sometimes they’re referred to as minor tranquillisers or, colloquially, as “benzos”.

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

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

Benzodiazepines used to be widely prescribed for long-term management of anxiety and insomnia. They are still prescribed for these conditions, but less commonly, and are also sometimes used as part of the treatment for cancer, epilepsy and alcohol withdrawal.

Long-term use can lead to tolerance: when the effect wears off over time. So you need to use more over time to get the same effect. This can lead to dependence: when your body becomes reliant on the drug. There is a very high risk of dependence with these drugs.

When you stop taking benzodiazepines, you may experience withdrawal symptoms. For those who are dependent, the withdrawal can be long and difficult, lasting for several months or more.

So now they are only recommended for a few weeks at most for specific short-term conditions.

How do people get them? And how does it make them feel?

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.

When used recreationally, benzodiazepines are usually taken at higher doses than those typically prescribed, so there are even greater risks.

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.

There are risks associated with using at these levels, including 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, which prevents your lungs from getting enough oxygen. In extreme cases, it can lead to unconsciousness and even death.

Using a high dose also increases risk of tolerance and dependence.

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 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 have been prescribed benzodiazepines but have 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 you do to reduce the risks?

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

Benzodiazepines should not be taken with other medicines without speaking to a doctor or pharmacist.

You should not drink alcohol or take illicit drugs at the same time as using benzodiazepines.

Counterfeit benzodiazepines are increasingly being detected in the community. They are more dangerous than pharmaceutical benzodiazepines because there is no quality control and they may contain unexpected and dangerous substances.

Drug checking services can help people identify what is in substances they intend to take. It also gives them an opportunity to speak to a health professional before they use. People often discard their drugs after they find out what they contain and speak to someone about drug harms.

If people are using benzodiazepines without a prescription to self manage stress, anxiety or insomnia, this 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 long term solutions.

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

There are also other medications with a much lower risk of dependence that can be used to treat anxiety and insomnia.

If you or someone you know needs help with benzodiazepine use, Reconnexions can help. It’s a counselling and support service for people who use benzodiazepines.

Alternatively, CounsellingOnline is a good place to get information and referral for treatment of benzodiazepine dependence. Or speak to your GP. The Sleep Health Foundation has some great resources if you are having trouble with sleep.

Nicole Lee, Adjunct Professor at the National Drug Research Institute (Melbourne based), Curtin University and Suzanne Nielsen, Professor and Deputy Director, Monash Addiction Research Centre, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What’s the difference? is a new editorial product that explains the similarities and differences between commonly confused health and medical terms, and why they matter.

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Former US First Lady Michelle Obama revealed in her memoir she had a miscarriage. UK singer-songwriter and actor Lily Allen has gone on the record about her stillbirth.

Both miscarriage and stillbirth are sadly familiar terms for pregnancy loss. They can be traumatic life events for the prospective parents and family, and their impacts can be long-lasting. But the terms can be confused.

Here are some similarities and differences between miscarriage and stillbirth, and why they matter.

Let’s start with some definitions

In broad terms, a miscarriage is when a pregnancy ends while the fetus is not yet viable (before it could survive outside the womb).

This is the loss of an “intra-uterine” pregnancy, when an embryo is implanted in the womb to then develop into a fetus. The term miscarriage excludes ectopic pregnancies, where the embryo is implanted outside the womb.

However, stillbirth refers to the end of a pregnancy when the fetus is normally viable. There may have been sufficient time into the pregnancy. Alternatively, the fetus may have grown large enough to be normally expected to survive, but it dies in the womb or during delivery.

The Australian Institute of Health and Welfare defines stillbirth as a fetal death of at least 20 completed weeks of gestation or with a birthweight of at least 400 grams.

Internationally, definitions of stillbirth vary depending on the jurisdiction.

How common are they?

It is difficult to know how common miscarriages are as they can happen when a woman doesn’t know she is pregnant. There may be no obvious symptoms or something that looks like a heavier-than-normal period. So miscarriages are likely to be more common than reported.

Studies from Europe and North America suggest a miscarriage occurs in about one in seven pregnancies (15%). More than one in eight women (13%) will have a miscarriage at some time in her life.

Around 1–2% of women have recurrent miscarriages. In Australia this is when someone has three or more miscarriages with no pregnancy in between.

Australia has one of the lowest rates of stillbirth in the world. The rate has been relatively steady over the past 20 years at 0.7% or around seven per 1,000 pregnancies.

Who’s at risk?

Someone who has already had a miscarriage or stillbirth has an increased risk of that outcome again in a subsequent pregnancy.

Compared with women who have had a live birth, those who have had a stillbirth have double the risk of another. For those who have had recurrent miscarriages, the risk of another miscarriage is four-fold higher.

Some factors have a u-shaped relationship, with the risk of miscarriage and stillbirth lowest in the middle.

For instance, maternal age is a risk factor for both miscarriage and stillbirth, especially if under 20 years old or older than 35. Increasing age of the male is only a risk factor for stillbirth, especially for fathers over 40.

Similarly for maternal bodyweight, women with a body mass index or BMI in the normal range have the lowest risk of miscarriage and stillbirth compared with those in the obese or underweight categories.

Lifestyle factors such as smoking and heavy alcohol drinking while pregnant are also risk factors for both miscarriage and stillbirth.

So it’s important to not only avoid smoking and alcohol while pregnant, but before getting pregnant. This is because early in the pregnancy, women may not know they have conceived and could unwittingly expose the developing fetus.

Why do they happen?

Miscarriage often results from chromosomal problems in the developing fetus. However, genetic conditions or birth defects account for only 7-14% of stillbirths.

Instead, stillbirths often relate directly to pregnancy complications, such as a prolonged pregnancy or problems with the umbilical cord.

Maternal health at the time of pregnancy is another contributing factor in the risk of both miscarriage and stillbirths.

Chronic diseases, such as high blood pressure, diabetes, hypothyroidism (underactive thyroid), polycystic ovary syndrome, problems with the immune system (such as an autoimmune disorder), and some bacterial and viral infections are among factors that can increase the risk of miscarriage.

Similarly mothers with diabetes, high blood pressure, and untreated infections, such as malaria or syphilis, face an increased risk of stillbirth.

In many cases, however, the specific cause of pregnancy loss is not known.

How about the long-term health risks?

Miscarriage and stillbirth can be early indicators of health issues later in life.

For instance, women who have had recurrent miscarriages or recurrent stillbirths are at higher risk of cardiovascular disease (such as heart disease or stroke).

Our research has also looked at the increased risk of stroke. Compared with women who had never miscarried, we found women with a history of three or more miscarriages had a 35% higher risk of non-fatal stroke and 82% higher risk of fatal stroke.

Women who had a stillbirth had a 31% higher risk of a non-fatal stroke, and those who had had two or more stillbirths were at a 26% higher risk of a fatal stroke.

We saw similar patterns in chronic obstructive pulmonary disease or COPD, a progressive lung disease with respiratory symptoms such as breathlessness and coughing.

Our data showed women with a history of recurrent miscarriages or stillbirths were at a 36% or 67% higher risk of COPD, respectively, even after accounting for a history of asthma.

Why is all this important?

Being well-informed about the similarities and differences between these two traumatic life events may help explain what has happened to you or a loved one.

Where risk factors can be modified, such as smoking and obesity, this information can be empowering for individuals who wish to reduce their risk of miscarriage and stillbirth and make lifestyle changes before they become pregnant.

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More information and support about miscarriage and stillbirth is available from SANDS and Pink Elephants.

Gita Mishra, Professor of Life Course Epidemiology, Faculty of Medicine, The University of Queensland; Chen Liang, PhD student, reproductive history and non-communicable diseases in women, The University of Queensland, and Jenny Doust, Clinical Professorial Research Fellow, School of Public Health, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.