As I said, if you search that LONG thread on benzos from a few months back, fast&bulbous actually provides the mechanism behind the toxicity. If memory serves the -NO2 (one of the Os becomes an -OH) is reduced to a hydroxy(oxo)ammonium radical which is hepatotoxic. Then, when it's fully reduced to an amine it exerts toxicity via another mechanism.
Just wanted to jump in and say that I've been linking that thread to benzo discussions wherever I can - I really appreciate your thoughtfulness about the unintended or uncaredfor consequences that is endemic in RC benzo design, development, and distribution. Your analysis in particular of the subtle and significant risks present with the this lineage of benzo drug development has been really informative for me. I see benzos as a tool that can be use incredibly useful under specific circumstances, and, as something I am cautious about using due to the risks inherent with their use. In particular, I have some nitrazolam that I've been very cautious about using. It is helpful for sleep, and also, I notice that there seems to be second day activity that almost makes you... less present? I'm guessing this is related to active metabolites. Combine that with the physical health risks and it's one to be cautious with for sure.
What frightens me about benzo related decline is the myopia that concurrently manifests - the loss of context over time, almost imperceptible as it is happening - not a path I'd like to walk down. Hopefully you can add this to the list of ways you know you've contributed, and are appreciated. I really appreciate getting to learn from you.
So use my knowledge while I'm still able to give it - that way at least I've done SOMETHING good in this world.
WRONG.
It's the nitrobenzodiazepines (nitrazepam, clonazepam, flunitrazepam and so on) that are toxic. They cause liver damage. fast&bulbous provided a really detailed set of information. Worse still, the more potent ones seem to be more toxic to the liver. I don't think the reason is known. The liver toxicity is from a 2017 study. The Swedish study is from 2012 because THEY couldn't understand it and why they don't use nitrobenzodiazepines any more.
It IS all on here, I promise.
I was also particularly moved by Keif's descriptor of how it happens. I have a version of this that I tell to people when describing the descent into opioid addiction when it relates to medical progression to addiction - how someone starts with a valid injury, and a script of hydrocodone. They take the pills when it hurts. One day , they get home after having a really shitty day at work, their boss was just laying into them about something, and they were also in a lot of pain. Taking that 5/325 hydro made all of it better, including the shitty day with the boss.
The arm heals, time passes, but at some point, that person has a day where they don't have any physical pain, but the shitty day pain is real, and there's a couple of vicodin left in the bottle. That's the moment it starts.
Sometimes, people work in jobs where they are in pain constantly, not enough to prevent them from working entirely, but enough to make them miserable. that miisery fucks with you until you finally act out and get what you need to take the edge off.
Sometimes you have chronic pain and at the same time you have emotional pain, and the two are so intertwined that the opioids become part of of just feeling safe.
It's subtle, but the shift does occur. You suddenly change from living a life in which you are thriving,to a life based on surviving. It is a a distinct line that you pass, I know it was for me. I remember waking up one day after doing dope over the weekend. I was sick. I was feeling it hit for the first time. We laughed about it. *whaddyagonnadooo?* - Dope. That's what you're gonna do. Dope before work this time. because you need to be right when you punch in for shift. And that's how it starts. It's goes from something you do outside of work to relax, and becomes something you do before work to function.
I have often wondered what people noticed in me during that shift. Did I seem the same, was there an abrupt shift? Did I have any tells that I had started down a bad path?
For a while, it isn't even so bad, your tolerance is low enough that you can afford it, pretty easily.... but the creep begins. You let those credit card payments drop to the minimum, before you start missing payments... partially because fuck it, partially because that means I have more money to buy dope.
I imagined that there are versions of this story in the benzo world, but they're shrouded in the memories lost along the descent. That's what frightens me the most about them. Opioids took people and things, but benzos take minds.
I think it's infinitely important here to talk about the definition of "perfect" for a sleeping pill.
I'm highly against anyone taking Benzodiazepines for longer than the 2-6 weeks maximum for which they're indicated or if they're otherwise used on a PRN basis. Benzodiazepines are great medicine, like Opioids, when used properly. Using them properly is a science. If you take too much from the well, it dries up.
They are "perfect" for acute indications. They're safe and effective. If you take them chronically, more often than not, they bite you. This doesn't start as a full-blown dependence. It begins in subtle ways, which is why people who should know better find themselves in the same situation.
It starts when it's a little harder to get to sleep or when you start feeling the pangs of anxiety after you wake up in the morning. Sleep gets a little harder, so you take an extra half a tablet because "you have a demanding day" or what have you. This makes it harder to get to sleep the next night. The anxiety in the mornings gets steadily worse.
This is the moment when a person realizes they're in the maw of something potentially dangerous. How do they get off? It's not like I'm gonna take a week off from work to get off these just for some little addiction. You keep going. The problem gets worse. It's like an event horizon in that once you're over the line, you might feel like you could go back easily, when in fact, you're hurdling toward the black hole the entire time.
By the time you're done, you can't sleep, your anxiety is fucked, you can't get more Benzodiazepines and you end up existing in a half-life of Benzodiazepines making you feel like shit but you're mind and body telling you that you need them to survive.
I know, this probably seems melodramatic. This is for folks who might not know any better. Benzodiazepines are fairly mild in their effects. It's not like when you do a shot of Heroin and you know full well you're dealing with something incredible.
There are people who use Benzodiazepines their entire life without issue. These would be far statistical outliers.
