Is diazepam a controlled substance?

In this article:

• Is diazepam a controlled substance?
• Side effects
• Drug interactions
• What can I take instead of diazepam?

In this article

• Is diazepam a controlled substance?
• Side effects
• Drug interactions
• What can I take instead of diazepam?

Introduction

Going it alone against a knotted stomach, sleep troubles, and impending dread of anxiety isn’t easy. That’s part of why doctors write millions of prescriptions for diazepam per year. Yet, for some people, diazepam might replace anxiety with dependence, which is why it’s classified as a controlled substance. What does that mean? How will it affect treatment? What else can you take? We’ve got the important information below.

What is diazepam?

Diazepam (brand name: Valium) belongs to a drug class called benzodiazepines. “It works by increasing the effects of GABA—our brain’s natural calming chemical,” according to Shebna N. Osanmoh I, PMHNP-BC, a psychiatric nurse practitioner at Savant Care. “Through my years of prescribing at different mental health facilities, I have seen it work to reduce anxiety, muscle tension, and seizures.” It’s also shown effectiveness in treating alcohol withdrawal symptoms and muscle spasms from neurological conditions like cerebral palsy or paraplegia. 

Diazepam also produces powerful sedative effects on the brain and body, which is why it’s typically only prescribed for adults over age 18. However, doctors may prescribe it for certain cases of muscle spasms or seizure disorders in children older than six months, under close supervision. According to the Valium label, it’s also contraindicated (should not be used) for anyone who has myasthenia gravis, severe respiratory issues, severe liver insufficiency, sleep apnea, or a known diazepam hypersensitivity.

On top of that, “diazepam is unique in that it is among the benzodiazepines with the longest half-life,” says Dr. Alex Dimitriu, MD, founder of Menlo Park Psychiatry & Sleep Medicine. “This is how long it stays in your system—for diazepam, it takes 30–56 hours to eliminate half the drug from your body.”

Is diazepam a controlled substance?

Yes, the United States Department of Justice designated diazepam as a controlled substance in 1971, when they signed the U.N.’s Convention on Psychotropic Substances. That means it shows some potential for abuse and dependence. The Controlled Substances Act (CSA) puts it under Schedule IV—along with medications like Xanax, Ambien, and tramadol—because it has a lower risk of abuse and dependence than drugs in higher schedules, such as Schedule II drugs like oxycodone and illegal (Schedule I) drugs like ecstasy. But that risk is still present, so it should be prescribed and taken with caution.

However, diazepam is not a narcotic. Sometimes, “controlled substance” and “narcotic” are viewed as interchangeable terms, but they’re not. A controlled substance is any drug whose production, possession, and use is restricted by the government. Narcotics, on the other hand, refer specifically to opioids, opium derivatives, and synthetic opioid substitutes. So, although diazepam is regulated, it is not a narcotic.

What does that mean for me?

Anyone taking or considering diazepam for their anxiety, seizures, or muscle spasms might be wondering how this all will affect their treatment or overall health. When taken under a doctor’s supervision and according to their exact directions, it’s often safe and effective. But it’s still good to know the potential risks and consequences.

Abuse and misuse

This is a large part of diazepam’s controlled substance classification, but what exactly does it mean? Essentially, the misuse of benzodiazepines means taking them in any way other than how they’re prescribed. According to the American Addiction Centers, this might include taking more than the indicated dose, taking them for non-medical reasons (i.e. to get high), taking them with other substances or alcohol, or crushing and snorting the pills. 

Per Dr. Dimitriu, signs of Valium abuse can include medication-seeking behavior (doctor shopping or forging prescriptions), overuse, a higher tolerance over time, withdrawal symptoms, and physical symptoms like slurred speech, drowsiness, or confusion.

Important: Due to diazepam’s potential for abuse, never take someone else’s prescription, or allow someone else to take yours. 

Addiction

The National Institute on Drug Abuse defines substance addiction as “a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.” For example, American Addiction Centers says diazepam addiction might manifest as:

• Nervousness
• Pounding heart
• Paranoia or nervousness
• Suicidal thoughts
• Getting prescriptions from different healthcare providers
• Travelling far to fill prescriptions
• Uncharacteristically poor job performance
• Problems with the law

If you’re experiencing diazepam addiction, contact an addiction treatment center, detox clinic, or call SAMHSA’s Addiction Helpline as soon as possible.

Withdrawal

Where there’s dependence, there’s a high potential for acute withdrawal reactions. According to an article in Addiction, benzodiazepine withdrawal might cause sleep issues, irritability, increased tension, panic attacks, tremors, sweating, trouble concentrating, nausea, weight loss, palpitations, headache, or muscle pain. 

That’s why patients should always get medical advice from a doctor before they stop taking diazepam, and avoid abrupt discontinuation of treatment. The doctor can draw up a plan to safely decrease the dosage and avoid withdrawal symptoms. 

Side effects

There are several other possible diazepam side effects, and per the Valium label, the most common side effects are:

• Drowsiness
• Fatigue
• Muscle weakness
• Ataxia (problems with balance or coordination). 

Additionally, it may cause serious side effects like breathing problems, suicidal thoughts, psychosis, slow heartbeat, seizures, low blood pressure, fainting, blood disorders, and liver problems. 

Drug interactions

Combining diazepam with other sedative or drowsiness-inducing substances or prescription drugs can compound the side effects, causing complications that can be severe or even life-threatening—such as breathing problems and coma. These include other benzodiazepines, opioid pain medicines, sleep medicines, antihistamines, and alcohol. It may also interact with other mental health medications, MAO inhibitors, phenytoin, cimetidine, omeprazole, fluoxetine, fluvoxamine, and ketoconazole, among others. Before taking diazepam, check with your healthcare provider to ensure that there are no drug interactions. Be sure to tell your provider about all the medications you take, including prescription and OTC drugs, vitamins, and supplements.

Other precautions

The drug’s label lists a few other precautions to consider before taking diazepam:

• Because it can cause dependence, diazepam should be prescribed with caution to anyone who has had a substance abuse disorder. 
• Pregnant or nursing mothers shouldn’t take it either, since it may harm the unborn or newborn baby. 
• Patients with pre-existing respiratory issues may require a lower dose, since the drug can cause respiratory depression. 
• Diazepam may increase the risk of suicidal thoughts, so it’s important to report these feelings to a health care provider right away.
• Since it can induce drowsiness and impair coordination, patients shouldn’t drive or operate machinery until they know how it affects them. 

Refills

Controlled substances also have refill restrictions to help prevent abuse. For Schedule IV substances like diazepam, federal law dictates that pharmacists cannot fill or refill a prescription more than six months after it was issued. On top of that, no prescription for a Schedule IV substance can be refilled more than five times. However, state laws vary. In states with more stringent laws than federal law, the more stringent law takes precedence.

While certain situations might require additional refills, doctors often only prescribe diazepam for short-term treatments. “I find Valium can be very effective when used properly for specific conditions, but I’m very conservative with prescribing it long term,” Osanmoh says. “I only use it short term or in specific situations where other treatments haven’t worked.”

Storage and disposal

No matter what the drug, it’s important that no one but the patient take it—either intentionally or unintentionally. But it’s especially important for controlled substances. “Store in a cool, dry place. A secure location is important as this is a controlled substance, and it should also be kept away from children. Try to contact your provider a few days prior to running out (and not over the weekend!),” Dr. Dimitriu says.

Proper disposal is crucial, too. It might seem harmless to toss unused pills in the garbage or flush them down the toilet, but that’s not always the case. The most ideal way to get rid of your medications is by dropping them off at a take-back location (here’s a helpful Google Maps link), or using a prepaid drug mail-back envelope. 

If that’s not possible, drugs on the FDA’s flush list can be flushed down the toilet. This includes the diazepam rectal gel but not other forms of diazepam, such as the oral tablets. For other forms, the DEA recommends removing them from their packaging, mixing them with an undesirable substance (kitty litter, used coffee grounds, etc.), sealing them in another bag or container, and placing them in the trash. 

What can I take instead of diazepam?

Despite its risks, diazepam has still helped millions of people with their anxiety, seizures, and other conditions. But it’s understandable if its controlled substance status is a little worrying. Fortunately, alternatives are available. According to Osanmoh, “these can include non-benzodiazepine medications like SSRIs for long-term anxiety management and non-pharmacological approaches like cognitive behavioral therapy, mindfulness, and stress management techniques. Through my work in crisis intervention I have seen many patients benefit from combining these approaches rather than just medication.”

The best option for a particular person depends on their medical condition, potential for abuse, other medications, and other factors. People who have anxiety, seizures, or muscle spasms might also benefit from drug classes like: 

• Selective serotonin reuptake inhibitors (SSRIs): Lexapro (escitalopram), Prozac (fluoxetine), Zoloft (sertraline)
• Selective norepinephrine reuptake inhibitors (SNRIs): Cymbalta (duloxetine), Effexor (venlafaxine) 
• Tricyclic antidepressants: amitriptyline, nortriptyline
• Muscle relaxants: Flexeril (cyclobenzaprine), Soma (carisoprodol), baclofen, Robaxin (methocarbamol) 
• Anticonvulsants: Neurontin (gabapentin), Tegretol (carbamazepine)
• Other benzodiazepines: Klonopin (clonazepam), Xanax (alprazolam), Ativan (lorazepam), Halcion (triazolam)

Drug name	Drug class	Indication	Controlled substance (Y/N)	SingleCare savings
Klonopin (clonazepam)	Benzodiazepine	Anxiety, panic disorder, seizures	Y	See latest prices
Xanax (alprazolam)	Benzodiazepine	Anxiety, panic disorder	Y	See latest prices
Ativan (lorazepam)	Benzodiazepine	Anxiety, panic disorder, seizures	Y	See latest prices
Halcion (triazolam)	Benzodiazepine	Insomnia	Y	See latest prices
Lexapro (escitalopram)	SSRI, antidepressant	Depression, anxiety	N	See latest prices
Prozac (fluoxetine)	SSRI, antidepressant	Depression, panic disorder, OCD, bulimia	N	See latest prices
Zoloft (sertraline)	SSRI, antidepressant	Depression, panic disorder, social anxiety, OCD, PTSD	N	See latest prices
Cymbalta (duloxetine)	SNRI, antidepressant	Depression, anxiety, fibromyalgia, diabetic nerve pain	N	See latest prices
Effexor XR (venlafaxine ER)	SNRI, antidepressant	Depression, anxiety	N	See latest prices
Elavil (amitriptyline)	Tricyclic antidepressant	Depression, mood disorders	N	See latest prices
Flexeril (cyclobenzaprine)	Muscle relaxant	Muscle spasms, pain	N	See latest prices
Soma (carisoprodol)	Muscle relaxant	Muscle spasms, pain	Y	See latest prices
Neurontin (gabapentin)	Anticonvulsant	Seizures, nerve pain	In some states	See latest prices
Tegretol (carbamazepine)	Anticonvulsant	Seizures, nerve pain	N	See latest prices