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.

Young people’s access to gender-affirming medical care has been making headlines this week.

Today, federal Health Minister Mark Butler announced a review into health care for trans and gender-diverse children and adolescents. The National Health and Medical Research Council will conduct the review.

Yesterday, The Australian published an open letter to Prime Minister Anthony Albanese calling for a federal inquiry, and a nationwide pause on puberty blockers and hormone therapy for minors.

This followed Queensland Health Minister Tim Nicholls earlier this week announcing an immediate pause on access to puberty blockers and hormone therapies for new patients under 18 in the state’s public health system, pending a review.

In the United States, President Donald Trump signed an executive order this week directing federal agencies to restrict access to gender-affirming care for anyone under 19.

This recent wave of political attention might imply gender-affirming care for young people is risky, controversial, perhaps even new.

But Australian courts have already extensively tested questions about its legitimacy, the conditions under which it can be provided, and the scope and limits of parental powers to authorise it.

What are puberty blockers?

Puberty blockers suppress the release of oestrogen and testosterone, which are primarily responsible for the physical changes associated with puberty. They are generally safe and used in paediatric medicine for various conditions, including precocious (early) puberty, hormone disorders and some hormone-sensitive cancers.

International and domestic standards of care state that puberty blockers are reversible, non-harmful, and can prevent young people from experiencing the distress of undergoing a puberty that does not align with their gender identity. They also give young people time to develop the maturity needed to make informed decisions about more permanent medical interventions further down the line.

Puberty blockers are one type of gender-affirming care. This care includes medical, psychological and social interventions to support transgender, gender-diverse and, in some cases, intersex people.

Young people in Australia need a medical diagnosis of gender dysphoria to receive this care. Gender dysphoria is defined as the psychological distress that can arise when a person’s gender identity does not align with their sex assigned at birth. This diagnosis is only granted after an exhaustive and often onerous medical assessment.

After a diagnosis, treatment may involve hormones such as oestrogen or testosterone and/or puberty-blocking medications.

Hormone therapies involving oestrogen and testosterone are only prescribed in Australia once a young person has been deemed capable of giving informed consent, usually around the age of 16. For puberty blockers, parents can consent at a younger age.

Can a child legally access puberty blockers?

Gender-affirming care has been the subject of extensive debate in the Family Court of Australia (now the Federal Circuit and Family Court).

Between 2004 and 2017, every minor who wanted to access gender-affirming care had to apply for a judge to approve it. However, medical professionals, human rights organisations and some judges condemned this process.

In research for my forthcoming book, I found the Family Court has heard at least 99 cases about a young person’s gender-affirming care since 2004. Across these cases, the court examined the potential risks of gender-affirming treatment and considered whether parents should have the authority to consent on their child’s behalf.

When determining whether parents can consent to a particular medical procedure for their child, the court must consider whether the treatment is “therapeutic” and whether there is a significant risk of a wrong decision being made.

However, in a landmark 2017 case, the court ruled that judicial oversight was not required because gender-affirming treatments meet the standards of normal medical care.

It reasoned that because these therapies address an internationally recognised medical condition, are supported by leading professional medical organisations, and are backed by robust clinical research, there is no justification for treating them differently from any other standard medical intervention. These principles still stand today.

What if parents disagree?

Sometimes parents disagree with decisions about gender-affirming care made by their child, or each other.

As with all forms of health care, under Australian law, parents and legal guardians are responsible for making medical decisions on behalf of their children. That responsibility usually shifts once those children reach a sufficient age and level of maturity to make their own decisions.

However, in another landmark case in 2020, the court ruled gender-affirming treatments cannot be given to minors without consent from both parents, even if the child is capable of providing their own consent. This means that if there is any disagreement among parents and the young person about either their capacity to consent or the legitimacy of the treatment, only a judge can authorise it.

In such instances, the court must assess whether the proposed treatment is in the child’s best interests and make a determination accordingly. Again, these principals apply today.

Have the courts ever denied care?

Across the at least 99 cases the court has heard about gender-affirming care since 2004, 17 have involved a parent opposing the treatment and one has involved neither parent supporting it.

Regardless of parental support, in every case, the court has been responsible for determining whether gender-affirming treatment was in the child’s best interests. These decisions were based on medical evidence, expert testimony, and the specific circumstances of the young person involved.

In all cases bar one, the court has found overwhelming evidence to support gender-affirming care, and approved it.

Supporting transgender young people

The history of Australia’s legal debates about gender-affirming care shows it has already been the subject of intense legal and medical scrutiny.

Gender-affirming care is already difficult for young people to access, with many lacking the parental support required or facing other barriers to care.

Gender-affirming care is potentially life-saving, or at the very least life-affirming. It almost invariably leads to better social and emotional outcomes. Further restricting access is not the “protection” its opponents claim.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. For LGBTQIA+ peer support and resources, you can also contact Switchboard, QLife (call 1800 184 527), Queerspace, Transcend Australia (support for trans, gender-diverse, and non-binary young people and their families) or Minus18 (resources and community support for LGBTQIA+ young people).

Matthew Mitchell, Lecturer in Criminology, Deakin University

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