Benzodiazepine use, abuse, and dependence

Given their widespread use, abuse potential (23), and related risks, surprisingly little is known about benzodiazepine misuse. We discussed the various trends observed regarding the benzodiazepines use during COVID-19 pandemic as reported in different studies. We reviewed benzodiazepine misuse and predict how the trends of benzodiazepine misuse may vary in the post-pandemic era. COVID-19 has been a global pandemic that has spiked the rates of anxiety and insomnia. Mental health professionals need to be prepared for issues that may arise due to COVID-19 such as anxiety, depression, fear, coronophobia, trauma and grief due to loss of a loved one.

Care Agreement

• These patients are more likely to die from methadone toxicity because of the synergistic effects of methadone and BZD [68].
• If patients are consuming prescribed medication faster than expected, why is this the case?
• It is important to know that people respond differently to medicines depending on their health, the diseases they have, genetic factors, other medicines they are taking, and many other factors.
• Long-term use is defined as two or more months at a therapeutic dose and when used long-term, BZDs pose potential harmful effects.
• We are also requiring updates to the existing patient Medication Guides to help educate patients and caregivers about these risks.
• Abrahamsson et al. investigated the relationship between hypnotic drug overdose versus non-overdose deaths in patients on opioid maintenance therapy.

To avoid serious problems, including withdrawal reactions, patients taking benzodiazepines should not suddenly stop taking them without first discussing with your health care professional a plan for slowly decreasing the dose and frequency. Contact your health care professional if you experience withdrawal symptoms or your medical condition worsens. Go to an emergency room or call 911 if you have trouble breathing or other serious side effects such as seizures.

• 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].
• As previously noted, limited population-based data on the prevalence of benzodiazepine misuse is available for countries outside of the U.S.
• If you have health insurance, your insurer can give you a list of providers and facilities covered by your plan.
• With the emerging coronavirus pandemic, most countries have updated their drug prescription policies [1].
• Flunitrazepam is one of the commonly abused drugs and has been referred to as date rape drug, roofies, or forget-me-pill [22].

Behavioral Signs of Benzo Abuse

Clinicians should monitor patients also prescribed stimulants or opioids for benzodiazepine misuse. Improved access to behavioral interventions for sleep or anxiety may reduce some misuse. The antiepileptic oxcarbazepine has also shown potential to ameliorate withdrawal symptoms more than older-generation antiepileptics such as carbamazepine [71].

Benzodiazepine Abuse

This information will describe the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions consistently across all the medicines in the class. We are also requiring updates to the existing patient Medication Guides to help educate patients and caregivers about these risks. As mentioned earlier, severe benzodiazepine withdrawal syndrome alone does not typically result in death (though withdrawal can be life-threatening). However, it appears that many people take benzodiazepines with alcohol, and this combination can be deadly.

When should I seek immediate care?

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Some studies in the past have shown that there is a correlation between chronic BZD use and a decline in cognitive function, including the development of dementia and dementia-like diseases. One study showed a potential for cognitive decline after BZD use in the elderly, but at the same time did not find a link between their use and the development of Alzheimer’s dementia [73]. The researchers in the study cautioned the prescription of BZD in the elderly due to the potential for cognitive decline [73].

Excluded studies include non-peer-reviewed publications, case reports, case series, review articles, and letters to editors. Studies involving substance abuse but not mentioning specifically benzodiazepine use were also excluded. PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse.

Among benzodiazepines, clonazepam, alprazolam, and oxazepam were the most frequently reported to be misused or abused [50]. Regular use of BZDs has been shown to cause serious, harmful psychological and physical dependence, leading to withdrawal symptoms similar to that of alcohol withdrawal. Regular use of BZDs can lead to tolerance, which is the physiologic dependence on the presence of BZDs in the body’s system. This can be linked to addiction as the patient is not just psychologically addicted to the substance, which can be seen with cravings, and physical addiction. Withdrawal, like with alcohol since they exert their effects on similar receptors, can be life threatening.

Benzodiazepines Overdose

Most patients reported that dependence and subsequent withdrawal symptoms developed even when the benzodiazepine (clonazepam, alprazolam, lorazepam, diazepam, triazolam, or oxazepam) was prescribed for therapeutic use. However, patients or others using these medications are unlikely to report directly to FDA about abuse or illicit uses. These cases reported a wide range of time to dependence, with some describing the onset as early as days to weeks after the start of a benzodiazepine.

Along with flunitrazepam (Rohypnol), alprazolam (Xanax) and clonazepam (Klonapin) may be used to incapacitate sexual assault victims. Not only do they affect your judgment, but these drugs can keep you from remembering what happened. Dosing differs depending on which benzodiazepine you take, as well as things like your size, gender, and whether you’re used to taking them.

This is more significant than the study by Weich et al. [47] which found a 2-fold increased hazard of death in 7 years. It was also reported that the risk of death in patients using less than 18 pills per year is increased by 3.6-fold [48]. The sedative effect of these drugs, as well as their addiction-forming chemical properties, makes them ripe for abuse. Since these are prescription drugs, it is critical to note that some individuals may initially have a legitimate medical reason to use them, but over time, they develop a use disorder.