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The story of modern tranquilliser drugs
Published in Adam Doble, Ian L Martin, David Nutt, Calming the Brain: Benzodiazepines and related drugs from laboratory to clinic, 2020
Adam Doble, Ian L Martin, David Nutt
A related concern is that of benzodiazepine abuse. If benzodiazepine dependence generally concerns individuals taking, albeit for an extended period, the prescribed (low) dose of a drug to treat an identified medical problem, abuse concerns the use of very high doses of benzodiazepines by individuals suffering from neither insomnia nor anxiety for essentially recreational ends. In the UK, benzodiazepine abuse concerns principally temazepam, and this has become a serious health issue. Benzodiazepine abuse has grown rapidly in the last decade, and this may be in part due to the low cost, guaranteed purity and ready availability of this particular product (generic temazepam sells for twopence a pill in the UK). In the US, flunitrazepam is widely abused, despite the fact that this hypnotic benzodiazepine is not marketed in the US, and thus has to be imported, with an associated increase in cost and risk. Abuse of benzodiazepines is often seen within the context of multiple substance abuse, involving alcohol, stimulants or opiates. Appropriate treatment of benzodiazepine abuse would benefit from better understanding of the effects of chronic use of high dose benzodiazepines on the central nervous system.
Pharmacological interventions
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
Benzodiazepines are used clinically to assist in managing people who have anxiety and sleep disorders. They work by increasing the effects of GABA in the brain. They are used in substance misuse treatment to manage alcohol withdrawal. Increasingly, benzodiazepines are a problem drug of abuse among young people. Benzodiazepines are widely available to young people through prescription drug diversion, and sales through Internet availability. Several treatment options are relevant to benzodiazepine dependence. Gradual tapering of benzodiazepines is probably the hallmark and the most effective treatment approach for benzodiazepine misuse. The tapering schedule for young people tends to be slower than for adults and detoxification may be accomplished within two to three months rather than the 7–21 days for adults.
Anxiolytics: Predicting Response/Maximizing Efficacy
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
The widespread use of benzodiazepines in the last 20 years has created alarm in some circles that a widespread problem of benzodiazepine abuse exists. Between 10 and 17% of adults in the Western World were taking benzodiazepines in 1971.197 In 1972, there were 70 million prescriptions for chlordiazepoxide or diazepam in the U.S.198 Estimates of the incidence of significant mental illness in Western populations approximate 30% of adults.199 In a large general practice study, less than 1% of nonmentally ill patients received tranquilizers, but 50% of mentally ill patients did.200 Benzodiazepine dependence has been demonstrated by Hollister et al., but its incidence is very low.201 In the 17-year period starting in 1960, there were less than 200 cases of benzodiazepine dependence reported in the literature.202 In western Europe, where systematic health data are collected routinely, in the last 20 years there have been about 400 cases of benzodiazepine dependence among greater than 400 million treated persons.203 The conclusion can be reached that the large numbers treated do not constitute benzodiazepine abuse.
Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions
Published in Expert Review of Neurotherapeutics, 2023
Harry A. Fagan, David S. Baldwin
RCTs of benzodiazepines in GAD demonstrate efficacy vs. placebo, however the dropout rates are higher in the benzodiazepine groups on average [18]. Benzodiazepines with a relatively long half-life are preferred in treatment of GAD, to prevent the need for multiple daily dosing. Common adverse effects of benzodiazepine treatment include cognitive effects (sedation, drowsiness, and mental slowing) and psychomotor impairment (including when driving), both related to increased GABAergic stimulation, and the development of tolerance and dependence [49]. Tolerance to benzodiazepines can occur for the anticonvulsant and sedative effects; however, it is less clear to what extent this occurs for the anxiolytic effects [49]. Dependence on benzodiazepines can also occur with an associated withdrawal syndrome, usually characterized by anxiety-related physical and psychological symptoms alongside perceptual disturbances [50]. Treatment of benzodiazepine dependence, usually entails the conversion of benzodiazepine polypharmacy to monotherapy and the gradual tapering of the total dose, combined with psychological support [51].
Mandatory use of prescription drug monitoring program and benzodiazepine prescribing among U.S. Medicaid enrollees
Published in Substance Abuse, 2021
Di Liang, Huiying Guo, Yuyan Shi
Benzodiazepines are a class of psychoactive drugs widely prescribed for the treatment of anxiety, insomnia, seizures, and sleep disorders. Benzodiazepine long-term use, non-medical use, and co-use with other drugs can be associated with detrimental or even life-threatening consequences. Long-term use was associated with increased risks of benzodiazepine dependence, cognitive decline, falls, fractures, and motor vehicle crashes.1–3 Non-medical use can result in overdose, hospitalizations, or death.4 Co-use of benzodiazepines and opioids was associated with a significant risk of mortality:5 prescription opioid deaths involving benzodiazepines consisted of 27.9% of all 41,491 deaths involving prescription opioids in 2014–2015.6
Clinical picture of benzodiazepine dependence: The role of different types of benzodiazepines
Published in Journal of Substance Use, 2019
Olivera Zikic, Gordana Nikolic, Jelena Kostic
The clinical presentation of benzodiazepine dependence is very complex. Physical dependence on benzodiazepines is typically characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, depression, hand tremor, sweating, concentration difficulties, dry wrenching and nausea, weight loss, palpitations, headache, muscular pain and stiffness, and perceptual changes (Bharadwaj, 2014; Longo & Johnson, 2000). The onset of suicidality is one of the possible outcomes of benzodiazepine dependence (Lekka, Paschalis, & Beratis, 2002).