Michael Cole, Anglia Ruskin University

Early toxicology reports suggest that former One Direction singer Liam Payne had several drugs in his system when he fell to his death from a hotel balcony in Buenos Aires, Argentina. These include pink cocaine (which comprises several drugs), cocaine, benzodiazepine and crack.

While the type of benzodiazepine wasn’t mentioned in the toxicology report, it is known that the police found a blister pack of clonazepam in the singer’s hotel room.

Although there has been a general fall in the use of benzodiazepines, clonazepam has bucked that trend. The reason for this is unclear, but it could be the drug’s potency. It is not without reason that on the street it is sometimes referred to as “super Valium”.

Clonazepam was first approved by the US Food and Drug Administration in 1975. It is used to treat a range of conditions, including epileptic seizures, muscle spasms, anxiety and panic disorders. Doses range from 0.5mg to 2mg in tablet or liquid forms. (By comparison, a teaspoon of sugar weighs about 5,000mg.) It is also 20 times more potent than diazepam (Valium), with 0.5mg of clonazepam being equivalent to 10mg diazepam.

The onset time for clonazepam – that is, the time to have an effect – is an hour or more. Xanax, also a benzodiazepine, starts to act within ten minutes, while Valium takes between 15 and 60 minutes.

Although slower to start acting, the effects of clonazepam are longer lasting than many benzodiazepines. For example, the half-life (the time taken for the body to reduce the amount of drug in the body by 50%) of Xanax is six to 25 hours, of Valium 48 hours and clonazepam up to 54 hours.

In recreational use, tablets are powdered and then snorted. The drug enters the bloodstream through the membranes in the nose. Taken this way the drug is faster to act and more is available in the bloodstream to have an effect.

The drug is thought to work by enhancing the activity of a brain chemical (neurotransmitter) called Gaba. It dampens brain activity by blocking the signals between neurons. Boosting Gaba is known to reduce anxiety, promote relaxation and help with sleep.

Steady rise

Recently there has been a rise in the use and misuse of clonazepam in the UK. Prescriptions for the drug increased by 12% in 2023. The UK Rehab website states: “The rise in clonazepam addiction reflects a larger trend in the misuse of prescription medications, a public health crisis that has escalated into epidemic proportions in some regions.”

Google searches for clonazepam have increased, with a particular interest in the drug in parts of the US. There are also reports of new polydrug mixtures containing clonazepam, such as karkoubi, which has been reported in Algeria and Morocco, mixing clonazepam with cannabis and tobacco.

Taking clonazepam is not without dangers. Even under medical supervision, people can develop tolerance to it and become dependent.

Doctors tend to prescribe low doses and then gradually increase the dose until the desired therapeutic effect is achieved. However, if the drug is taken over long periods (four weeks is often cited) people can become dependent. Withdrawal symptoms – such as tremors, sweating and nausea – are then experienced when the patient stops taking the drug.

Clonazepam also causes side-effects that can include trouble speaking, feeling sleepy, a slower heartbeat and excitability. Although rarer, some people hallucinate.

When mixed with other drugs or alcohol, the problems are compounded. For example, mixing with opiates and opioids (for example, codeine, methadone, morphine, oxycodone and tramadol) or alcohol can lead to sedation, slower breathing and heart rate, coma and even death.

Taking drugs in combination is known to be extremely dangerous. More than 93% of drug deaths in Scotland in 2021 involved more than one drug.

With these potential dangers, clonazepam is tightly controlled internationally. In the UK, it is a class C drug under the Misuse of Drugs Act. Other class C drugs include GHB, tramadol, cathinone and anabolic steroids.

But tough laws alone will not stop drugs from being misused. So when people choose to take drugs, including clonazepam, it is important that they understand what the drug might do and what the risks might be.

Michael Cole, Professor of Forensic Science, Anglia Ruskin University

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