Current benzodiazepine issues

Abstract

This article deals with some of the recent evidence bearing on the issues of the liability of benzodiazepines to lead to abuse, dependence, and adverse behavioral effects. Reviews of epidemiological, clinical and experimental literature indicated that the previous conclusion about abuse of these drugs still holds: the vast majority of the use of benzodiazepines is appropriate. Problems of nonmedical use arise nearly exclusively among people who abuse other drugs. Nevertheless, there are reasons for concern about patients who take benzodiazepines regularly for long periods of time. These drugs can produce physiological dependence when taken chronically, and although this does not appear to result in dose escalation or other evidence of "psychological dependence," physiological dependence can result in patient discomfort if drug use is abruptly discontinued. Also, physicians are currently prescribing shorter-acting benzodiazepines in preference to longer-acting benzodiazepines. The shorter-acting drugs can produce a more intense withdrawal syndrome following chronic administration. Furthermore, rates of use of benzodiazepines increase with age, and elderly patients are more likely than younger ones to take the drug chronically. The clearest adverse effect of benzodiazepines is impairment of memory. This, too, may be particular concern in older patients whose recall in the absence of drug is typically impaired relative to younger individuals, and who are more compromised following drug administration.

Correlates of nonmedical use of prescription benzodiazepine anxiolytics: results from a national survey of U.S. college students

“…Overall, the higher rates of substance use and other risky behaviors found among nonmedical benzodiazepine anxiolytic users provides evidence that this form of drug use is likely part of a larger cluster of problem behaviors (Jessor et al, 1991). The pattern of polydrug use among nonmedical benzodiazepine anxiolytic users found in the present study is consistent with previous findings showing the nonmedical use of benzodiazepine anxiolytics occurs largely among people who use other drugs (Woods and Winger, 1995).…”

“…Longitudinal research is necessary to examine the relationship between nonmedical use of prescription benzodiazepine anxiolytics and development of substance use disorders (Zacny et al, 2003). Despite the high prevalence and recent increases in nonmedical use, prescription benzodiazepines remain a highly effective and safe medication for the majority of patients (Woods and Winger, 1995). However, findings from the present study provide strong support for the hypothesis that the nonmedical use of prescription benzodiazepine anxiolytics represents a problem among certain segments of the college student population that needs to be deterred with effective prevention efforts and therapeutic strategies while not hindering effective clinical treatment of anxiety disorders and panic attacks.…”

The relationship between past-year drinking behaviors and nonmedical use of prescription drugs: Prevalence of co-occurrence in a national sample

“…It is important to note that prescription opioids, stimulants, sedatives, and tranquilizers are safe and effective medications for the majority of patients who take these drugs as prescribed by a health care professional to treat conditions like acute and chronic pain, attention deficit hyperactivity disorder (ADHD), anxiety disorders, and sleep disorders (Goldman et al, 1998;Greenhill et al, 2002;Savage, 2003;Woods and Winger, 1995). However, based on the high rates of NMUPD among individuals with AUDs, clinicians are encouraged to conduct thorough drug use histories when working with individuals with AUDs.…”

The Mouse Defense Test Battery: pharmacological and behavioral assays for anxiety and panic

“…However, these compounds have come under critical review because of the problems of drug dependence, tolerance, suppression of rapid eye movement sleep, rebound insomnia, and amnesia (Lader, 1994;Woods and Winger, 1995). Benzodiazepines produce their pharmacological effects by allosterically and positively modulating the action of GABA at GABA A receptors at specific ionotropic sites (Squires et al, 1979).…”