Where the substance comes from
Three routes. The prescription first: a treatment started for insomnia or long-lasting pain whose ending was never planned. Then the family medicine cabinet: the home cupboard is teenagers' first source of supply, ahead of dealers. Finally online sales, where identical-looking counterfeits circulate, some containing fentanyl.
A little history
The misuse of medicines is as old as medicines themselves: nineteenth-century laudanum and opium soothing syrups, sold without prescription, already created dependants by the thousand. The twentieth century brought barbiturates — Bayer's Veronal in 1903 —, sleeping pills made dangerous by the narrow gap between an effective and a fatal dose, responsible for many suicides and overdoses until the 1960s.
Benzodiazepines replaced them: chlordiazepoxide (Librium) in 1960, then diazepam (Valium) in 1963, discovered by Leo Sternbach at Roche. Much safer in overdose, they were prescribed massively — Valium was the best-selling drug in the United States from 1969 to 1982, and the Rolling Stones devoted Mother's Little Helper to it in 1966 — before dependence and withdrawal syndromes were recognised in the 1980s.
The next waves were those of opioid painkillers (codeine, tramadol, oxycodone) and of psychotropic medicines mixed into soft drinks or taken for their effects: France made codeine prescription-only in July 2017 after teenage deaths, and diverted tramadol has become a street drug in West Africa and the Middle East. Gabapentinoids (pregabalin) are the most recent concern.
The forms it takes
- Benzodiazepines and z-drugs (tranquillisers, sleeping pills), taken alone, with alcohol, or to come down after a stimulant.
- Weak opioids: codeine, tramadol, often as syrup mixed into a soft drink with sweets.
- Prescribed stimulants for attention disorder, misused around exams or to lose weight.
- Cough suppressants and antihistamines at high dose, for hallucinogenic effects.
What the user is looking for
Sleep, relief from anxiety, blotting out a memory, intellectual performance, sometimes simply boredom. What they share is apparent legitimacy: they are medicines, so “it is not drugs”. Dependence nonetheless installs by the same mechanisms.
Immediate unwanted effects
- Drowsiness, unsteadiness, falls, road accidents.
- Amnesia for the hours after taking them, especially with alcohol.
- Benzodiazepine + opioid + alcohol: the deadliest combination, because all three depress breathing and their effects add up.
- Paradoxical disinhibition: aggression, impulsive acts including self-harm.
Medium and long-term risks
Benzodiazepine dependence installs within a few weeks of daily use. Its withdrawal must never be improvised: stopping abruptly can cause seizures and delirium, and it must be gradual, over weeks or months, with a doctor. Prolonged use adds memory and attention problems, falls in older people, and a worsening of the very anxiety they were meant to treat.
Never stop on your own
For alcohol and for benzodiazepines, abrupt withdrawal can kill. They are the only two families where stopping without medical support is dangerous in itself.
How to spot use
Empty boxes or part-used blisters outside any treatment, prescriptions multiplied across several doctors, medicines vanishing from the cabinet, daytime drowsiness, slurred speech, falls, irritability on days without. Urine detection for benzodiazepines: a few days, up to several weeks for long half-life molecules.
Why the effect is stronger in adolescents
At the same dose in a lighter body, the concentration reached is higher in an adolescent than in an adult. More importantly, the reward circuit matures well before the prefrontal cortex that is supposed to restrain it: the pull to repeat is stronger and the brake weaker, which markedly shortens the gap between first use and problem use. Use established before eighteen multiplies the risk of adult dependence whatever the substance — including legal ones such as the caffeine in energy drinks, alcohol or nicotine.
When to call an ambulance without hesitating
Loss of consciousness, seizures, severe confusion, slow or irregular breathing, blue lips, chest pain, very high temperature, uncontrollable agitation, suicidal thoughts. In those situations call the emergency services and say what was taken: treatment depends on it, and nobody is prosecuted for calling to save someone.