Benzodiazepines and Similar Drugs: Misuse, Abuse, and Dependence

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Benzodiazepines and Similar Drugs: Misuse, Abuse, and DependenceRandy Brown, MD University of Wisconsin, Madison Alcohol Medical Scholars ProgramCopyright Alcohol Medical Scholars Program

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Key PointsDaily use of benzodiazepines (BZs) = risky Certain situations ↑ risk Prescribing practices/med characteristics Patient characteristics Taper BZs slowly if daily use ~2+ weeksCopyright Alcohol Medical Scholars Program

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What Are Benzodiazepines (BZs) ?Sedative-hypnotic Flurazepam (Dalmane) Temazepam (Restoril) Triazolam (Halcion) Anxiolytic Alprazolam (Xanax) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Diazepam (Valium)Copyright Alcohol Medical Scholars ProgramRelated meds = Non-BZ BZ receptor agonists (BZRAs) Zolpidem (Ambien)

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Adverse EffectsMotor impairment (reaction time) Cognitive impairment (sedation, amnesia) Increased risk Age > 65 Alcohol Using >1 BZ Highly lipid soluble BZ (e.g. diazepam)Copyright Alcohol Medical Scholars ProgramBZRAs ≤ BZs

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“Misuse” & Use DisordersMisuse Long-term Non-medical Abuse = dysfunction in 1+ areas Dependence = 3+ of 7 criteria repetitively Physical dependence (2 criteria) Compulsive use/loss of control (5 criteria)Copyright Alcohol Medical Scholars Program

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Misuse: Medication Factors Dose/duration ↑ dose 2+ weeks daily use Short half-life Triazolam ~6 hrs vs. chlordiazepoxide ~20 hrs Highly lipid soluble BZ (e.g. diazepam) Copyright Alcohol Medical Scholars Program

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Misuse: Patient FactorsSubstance dependence history BZs, alcohol + Psychiatric history Anxiety, depression + Social & demographic factors Age, gender, unemployment, poor social support + Copyright Alcohol Medical Scholars Program

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Tapering BZs1) 2-4 doses daily 2) Taper 25% every 3 days 3) Slower in last half Provide support behavioral therapy engage close familyCopyright Alcohol Medical Scholars Program

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SummaryLong-term use (> 2 weeks) ↑ risk for: Side effects Misuse, abuse, & dependence Prescribing practices & patient characteristics ↑ risk If taken for > 2 weeks, taper slowlyCopyright Alcohol Medical Scholars Program

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Last Updated: 8th March 2018

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