In 1965 The Rolling Stones recorded the song “Mother’s Little Helper” about a “little yellow pill”. That little yellow pill was Valium. Once thought to be the safest anti-anxiety medication on the market, Valium (diazepam) has enjoyed wide popularity as a sedative since its production began. However, the growing drug crisis in the United States has brought to light the addictive properties of diazepam and other similar medications, resulting in more restrictions and safety recommendations regarding the use of this drug. This article will explain what Valium is and how it is used and will answer questions about the risks for overdose from and addiction to diazepam.
Valium, also known by its generic name, diazepam, is a prescription medication that comes in pill or liquid form and is taken orally. It is used to treat the following conditions:
Symptoms of alcohol withdrawal
Sedation prior to surgery
Valium belongs to a class of medications called benzodiazepines. These medications work by raising the levels of gamma-aminobutyric acid (GABA) in the brain and improving GABA’s ability to bind to receptors that receive anxiety-producing signals. Through this process, the GABA blocks those signals and reduces anxiety.
Diazepam first became available on the market in 1963. Considered safer than the tranquilizers used to treat anxiety in the 1950s, Valium was widely used and became one of the top-selling drugs of all time.1 Sales of Valium peaked in 1978 with over 2 billion diazepam tablets sold that year.2 While it’s typically prescribed for the conditions listed above, doctors began prescribing Valium and other benzodiazepines for back pain and chronic pain in the early 2000s. Between 2003 and 2015, the percentage of outpatient physician visits that resulted in the prescription of diazepam or another benzodiazepine rose from just below 4% to 7.4%, doubling during the time period.
Possibly due to concerns over the addictive properties of benzodiazepines and their potential for abuse along with opioids, the rate of prescriptions began to decline in 2016, falling to the 135th most often prescribed medication in 2017 with 5,184,806 prescriptions reported.3 The following chart shows the number of prescriptions dispensed from 2007 to 2017, according to the Medical Expenditure Panel Survey (MEPS) 2007-2017, accessed through the ClinCalc DrugStats Database.4
This chart shows variable trends in the popularity of Valium use over recent years, with a peak in 2014 and 2015 and a fairly steep decline in sales since that time.
As a result of the increase in the misuse of and addiction to Valium in the 1970s, diazepam was placed on the United States Drug Enforcement Agency’s (DEA) Controlled Substances list in 1975. Valium is a Schedule IV controlled substance, meaning that the drug has a lower potential for abuse than other drugs on the more restrictive schedules. The DEA still considers diazepam to have a low risk of abuse and addiction even with its controlled status.
When taken with a prescription under the supervision of a qualified physician, Valium is a safe medication. In fact, during the 1960s it was considered a very safe medication with a low potential for abuse or addiction. By the 1970s this reputation as a safe medication caused a significant increase in over prescription and misuse of diazepam, with a resulting increase in addiction to the drug.5
Valium does have the potential for addiction. Physical dependence on the drug is more of a risk, which is why the dose of diazepam must be increased gradually when starting the medication and decreased gradually when the medication is stopped. This is called ramping. If Valium is not ramped up and down, a person can experience severe side effects.
Valium also has the risk for drug interactions. As a benzodiazepine, it acts to slow down the central nervous system. This affects the speed with which the body’s functions occur, including breathing. When diazepam is combined with other medications that also slow down the body’s functions, the rate of breathing can decrease to dangerously slow levels, resulting in brain damage or death. Drugs and substances that can cause this reaction when combined with Valium include:6
Other sedative medications
In addition, diazepam is not safe for people with certain medical conditions. These conditions are:
Acute angle-closure glaucoma
History of drug dependence
History of allergic reactions to Valium
Severe respiratory insufficiency
Severe liver insufficiency/liver failure
Another consideration is that eating grapefruit or drinking grapefruit juice can block the enzyme that breaks Valium down in the body, causing extremely high levels to build up in the body and increasing the risk of side effects. People who take Valium should avoid grapefruit and grapefruit juice.7
The more common side effects of diazepam include:
Lack of inhibition
Muscle tremor and dystonia
Lack of coordination
More rare, serious side effects of Valium are as follows:
Low blood pressure
Paradoxical CNS stimulation8
One adverse reaction that can occur with diazepam use is propylene glycol syndrome. This condition can occur when diazepam is administered through an intravenous solution (IV). Propylene glycol is used in the liquid suspension used to give diazepam through an IV. If this method of treatment is used for large doses of diazepam or if IV treatment is used long term, propylene glycol can build up in the body and cause substances in the body, such as sodium and potassium, to become out of balance. Symptoms of propylene glycol syndrome include:9
Low blood pressure
Hemolysis (destruction of red blood cells)
Acute kidney injury
Multiple organ failure
Benzodiazepine medications, in general, have a low risk for overdose, and of this medication class, diazepam is one of the safer forms. Doses of diazepam have to be quite high before the risk of overdose exists, but it can occur. A mild overdose of Valium can cause the following symptoms:
A more substantial, severe overdose may cause these symptoms:
Low blood pressure
Slow or absent reflexes
Low muscle tone
On rare occasions, coma and death may result from a Valium overdose, but the amounts that must be ingested are exceedingly high.10
More often, overdoses involving Valium occur when a person has taken diazepam in combination with other substances such as alcohol, opioids, or other sedative medications. Since these substances also act to slow down the central nervous system, combining them with diazepam could result in a severe slowing or shutdown of bodily functions, including breathing and heart function. Combining Valium or any benzodiazepine medication with other drugs offers a much higher risk of severe or fatal overdose than taking too much diazepam by itself. In 2015, the Centers for Disease Control (CDC) found that 23% of people who died from overdoses of opioids also tested positive for benzodiazepines.11 A disturbing trend is also seen in teenagers, who experienced an increase in overdoses involving benzodiazepines of 54% between 2000 and 2015.12
If a severe overdose involves benzodiazepines, the drug Flumazenil may be used to reverse the effects. Flumazenil acts as an antagonist on the receptors in the brain that respond to benzodiazepines, reversing the effects that the benzodiazepines have on the body. If a person has a tolerance to benzodiazepines, however, Flumazenil may worsen symptoms by causing withdrawal symptoms, seizures, and instability of autonomic functions like heart rate or breathing.13
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the United States Department of Health & Human Services, about 5.4 million people age 12 and older misused benzodiazepines in 2018.14 Valium, along with other benzodiazepines, is most often misused by people who have legal prescriptions to take the medication. A person who takes diazepam may take the prescribed does for much longer than originally intended or may take more pills more often than the prescription instructs them to do. This can lead to physical dependence and possible addiction.
Also, diazepam and other benzodiazepines are often abused by people who abuse other drugs, such as alcohol, cocaine, or opioids. These people use Valium to intensify the “high” that they get from depressant drugs such as opioids or to counteract the effects of stimulant drugs such as cocaine. Long term drug abusers sometimes use Valium to try to self-medicate while attempting to stop taking drugs.
People who abuse diazepam along with other drugs usually acquire the drug through illicit means, including obtaining prescriptions from several doctors at a time, forging prescriptions, or stealing pills from friends and family members. Illegally obtained Valium can also be purchased through street traffickers. The DEA reports that forensic laboratories across the United States reported 4451 cases involving illicitly diverted diazepam in 2017, with 3421 cases estimated for 2018.15
Street names for Valium include:16
The chances of becoming addicted to Valium are low if it is used on a short-term basis under the supervision of a physician. If used long term at higher doses than prescribed or if used in combination with other addictive drugs, the possibility of developing physical dependence and addiction becomes much higher. If a person becomes dependent on diazepam, withdrawal symptoms will appear if the drug is stopped abruptly.
Symptoms of withdrawal from Valium include:
Because of the withdrawal symptoms of diazepam, stopping long term use must be done gradually. People who have taken diazepam in lower doses may be able to go through this process on an outpatient basis with supervision from a physician. For people who have taken Valium in high doses or who have taken the drug in combination with alcohol or other drugs, this process should occur as a part of detoxification or “detox”. The detox process occurs under the close supervision of health care professionals who can monitor withdrawal symptoms and make sure that the removal of drugs from the body occurs safely. This is best done in an inpatient drug rehabilitation center.
Valium is a long-acting benzodiazepine, so other medications are not typically required to manage symptoms of withdrawal during treatment. If the risk of seizures or cardiac problems is present, anti-seizure and blood pressure medications may also be used to manage symptoms. Medications may also be used to manage the symptoms of withdrawal from other drugs in a person’s system. In fact, Valium is often used to manage symptoms during detox from alcohol addiction. If a person has become addicted to Valium in combination with alcohol or opioids, however, another benzodiazepine may be used to manage symptoms while the multiple drugs are removed from the system. Clonazepam, another long-acting benzodiazepine, is often used for this purpose.
Once detox has been completed, other treatments to help a person develop drug-free behaviors can occur. These may include:
The most common form of behavioral treatment for addiction to benzodiazepines. This form of therapy involves one to one counseling in which the person works with the counselor to identify the thought patterns associated with Valium use and to develop strategies to change these thought patterns without relying on Valium.
This type of therapy involves learning strategies to control the behaviors associated with Valium use. It is often used concurrently with other behavioral treatment strategies.
This is a process in which a person is exposed to those situations that trigger Valium use. The exposure occurs in a controlled environment and allows the person to think about and use alternate coping strategies.
Members of a person’s immediate family are included in this type of counseling, which helps repair relationships that have been damaged by Valium use.
Ironically, while Valium was gaining popularity in the 1960s, The Rolling Stones referred to the dangers of an overdose in their song. Valium can be used safely if taken carefully under the supervision of a physician, but it is not a safe drug. The risks of overdose and addiction when taken without following a prescription or when taken for recreational purposes are very real and dangerous. Anyone who shows the signs of being addicted to Valium should get professional medical help as soon as possible.