Long-term use of BZD leads to negative changes in sleep microstructure in patients with insomnia 35. For example, he cites a 2001 article by van Haaren, Lapane, and Hughes as a source of evidence that “in many cases benzodiazepines were overprescribed.” In fact, this paper does not provide evidence that benzodiazepines were overprescribed. Van Haaren concluded that the triplicate prescription policy “did affect prescription and administration of benzodiazepines in nursing homes in states with, versus without, a triplicate prescription policy.
4. Complications of Benzodiazepine Abuse
Rates of tranquilizer and sedative misuse are lower in adults over the age of 50, as compared to younger age groups (Maust et al., 2018; Schepis et al., 2018b), and are lower than rates of prescription opioid misuse in this age group (Blazer and Wu, 2009). Yet, the prevalence of lifetime and past-year tranquilizer misuse increased among this age group from 2002–2003 to 2012–2013 (from 4.5% to 6.6% and 0.6% and 0.9%, respectively; Schepis and McCabe, 2016). In addition, the proportion of individuals with past-year tranquilizer https://ecosoberhouse.com/ misuse who are over the age of 50 doubled from 2005–2006 to 2013–2014 (from 7.9% to 16.5%; Palamar et al., 2019). Benzodiazepine misuse and dependence appears to be more common among older adults with a prescription or who are treated in psychiatric settings (Landreat et al., 2010; Voyer et al., 2009; Yen et al., 2015).
Benzodiazepine Use Dangers
Of note, adding cognitive-behavioral therapy (particularly, interoceptive exposure-based treatment) to a slow benzodiazepine taper enhances success among people seeking to discontinue benzodiazepine prescriptions (Otto et al., 2010; Otto Sobriety et al., 1993). Accordingly, such approaches may also have promise for the treatment of benzodiazepine misuse, particularly given the strong link between anxiety and benzodiazepine misuse (McHugh et al., 2018; McHugh et al., 2017). Longitudinal studies should examine risks for the development of misuse, factors influencing the transition from prescribed use to misuse and from oral routes of administration to non-oral routes of administration (including injection use), and factors influencing the escalation to SHA use disorder. In addition, longitudinal studies will help to determine the temporal associations between benzodiazepine misuse and potential consequences (e.g., suicidality, poor physical health). Such studies would inform the development of screening tools to identify people at the highest risk for benzodiazepine misuse and the identification of factors that may be important targets for the prevention and treatment of benzodiazepine misuse.
The epidemiology of benzodiazepine misuse: A systematic review*
Since benzodiazepines are prescription drugs, some individuals who have a sedative use disorder will get a high volume of this drug by “doctor shopping.” Getting a few prescriptions from different doctors can occur, and individuals will have to fill these prescriptions at different pharmacies. Prescription bottles and their labels will reveal if an individual has different prescriptions from different doctors, filled by different pharmacies within the same timeframe. The most effective treatment for benzodiazepine use disorder is to gradually reduce how much of the drug you use under the supervision of a medical professional. You can do this in a treatment facility or hospital, or at home with the help of your doctor. Benzodiazepines, sometimes called benzos, are a type of medication known as tranquilizers. These drugs slow down your central nervous system, cause sedation and muscle relaxation, and lower anxiety levels.
- If any serious symptoms emerge such as signs of benzodiazepine overdose the best practice is to seek immediate help, which can include going to a local emergency room or contacting a doctor.
- In contrast, the aging Baby Boomers—who comprise nearly the entire 50–64 group in this analysis—have higher rates of alcohol and other substance use compared to aging adults before them (19, 20, 29).
- Longitudinal studies should examine risks for the development of misuse, factors influencing the transition from prescribed use to misuse and from oral routes of administration to non-oral routes of administration (including injection use), and factors influencing the escalation to SHA use disorder.
- Van Haaren concluded that the triplicate prescription policy “did affect prescription and administration of benzodiazepines in nursing homes in states with, versus without, a triplicate prescription policy.
3.5. Substance Use.
Only a very small percentage of people who take normal doses for short periods will become dependent on benzodiazepines. They are used for immediate symptom relief of anxiety, epilepsy and other seizure disorders, spasticity from CNS pathology, catatonia, sleep disorders such as insomnia, and withdrawal from alcohol and other BZDs 3. Chronic use of BZDs has been linked to a decline in cognitive function, increased risk of dementia and dementia-like illnesses, and impaired sensory and motor function in the elderly, as well as aggressive behavior and expressive anger in a subset of consumers 15,75. Other studies have shown that there is no correlation between BZD use and cognitive decline. One study showed that administration of BZD in patients with Alzheimer’s disease do not lead benzodiazepine withdrawal syndrome to further cognitive decline after 18 months of taking the drug 74.
They can be misused to achieve the high that benzodiazepines produce or more commonly they are used to either enhance the effects of other CNS depressant drugs, to stave off withdrawal effects of other drugs or combat the effects of stimulants. As many as 30–50% of alcoholics are also benzodiazepine misusers.14 Drug abusers often abuse high doses or even therapeutic doses for long periods of time which makes serious benzodiazepine withdrawal symptoms such as psychosis or convulsions more likely to occur during withdrawal. Most notably, benzodiazepine-related overdose deaths increased by more than 400% from 1996–2013 (Bachhuber et al., 2016) and emergency department visits for benzodiazepines increased by more than 300% from 2004 to 2011 (Jones and McAninch, 2015). These increases have occurred concurrently with rising rates of benzodiazepine prescribing. The number of benzodiazepine prescriptions not only increased 67% from the mid-1990s to 2013, but the quantity (i.e., dose equivalents) increased more than 3-fold over this time period (Bachhuber et al., 2016).
Benzodiazepines Risk, Abuse, and Dependence
The ultimate concern is that such fetuses will later be susceptible to autism, learning difficulties, attention deficit disorder, and general hyperactivity 24. The use and discontinuation of alprazolam within 2 weeks disrupt sleep onset and quality, increasing suicide risks 51. A study analyzing over 1000 cases of oxycodone-related drug abuse deaths showed that BZDs are among the most abused drugs by individuals using multiple drugs of abuse.
1. Symptoms of Withdrawal
In a survey of British general practitioners, many reported pressures in prescribing BZD to patients and a lack of adequate knowledge on alternative psychological treatment for insomnia 41. Manconi et al. explored the effects of long-term BZD use on sleep architecture and microstructure in those with insomnia. They found significant changes in sleep microstructure in chronic insomnia with high dosage abuse of BZD, but sleep architecture changes were not significant.
The dose required to produce respiratory compromise is difficult to quantify and depends on multiple factors, including dosage, tolerance, weight, age, coingestants, and even genetics. Patients with severe toxicity will present in a stuporous or comatose state, and immediate airway management and mechanical ventilation may be required. Finally, the thorough review by Engin discussed the mechanisms underlying the abuse/misuse-related effects of benzodiazepine-type drugs. The author reviewed studies suggesting that α1-containing GABAA receptors may play an important role in benzodiazepine reinforcement, tolerance and dependence. The findings summarized in this review highlight the progress in the field of benzodiazepine research, yet also emphasize the need for further, systematic investigations elucidating the mechanisms underlying benzodiazepine misuse, abuse and dependence.
The subjects in this study had mild to moderate Alzheimer’s dementia and showed no change in AD-Cog scores after treatment with BZD 74. Researchers in this study also cautioned, however, that these drugs are known to cause delirium, falls, and other adverse events in the elderly, so when possible, prescribers should either abstain from prescribing BZD to elderly patients or deprescribe them when possible 74. Additionally, BZD have been shown not to increase or decrease Mini Mental Status Exam (MMSE) scores, caregiver burden (CB), or the Neuropsychiatric Inventory (NPI) in Alzheimer’s patients over 12 months of treatment in one cohort study 75. Interestingly, in this same study, SSRIs and atypical antipsychotics showed the same results; however, trazodone actually improved the NPI 75. Other studies have assessed different methods of counseling on BZD dangers and alternatives to patients alongside a gradual taper off the drugs. One study compared the mainstay of treatment with a standardized interview/counselling approach to treatment 72.