The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry

Department of Psychiatry, University of Newcastle upon Tyne, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Current Opinion in Psychiatry (Impact Factor: 3.94). 06/2005; 18(3):249-55. DOI: 10.1097/01.yco.0000165594.60434.84
Source: PubMed


Despite repeated recommendations to limit benzodiazepines to short-term use (2-4 weeks), doctors worldwide are still prescribing them for months or years. This over-prescribing has resulted in large populations of long-term users who have become dependent on benzodiazepines and has also led to leakage of benzodiazepines into the illicit drug market. This review outlines the risks of long-term benzodiazepine use, gives guidelines on the management of benzodiazepine withdrawal and suggests ways in which dependence can be prevented.
Recent literature shows that benzodiazepines have all the characteristics of drugs of dependence and that they are inappropriately prescribed for many patients, including those with physical and psychiatric problems, elderly residents of care homes and those with comorbid alcohol and substance abuse. Many trials have investigated methods of benzodiazepine withdrawal, of which the keystones are gradual dosage tapering and psychological support when necessary. Several studies have shown that mental and physical health and cognitive performance improve after withdrawal, especially in elderly patients taking benzodiazepine hypnotics, who comprise a large proportion of the dependent population.
Benzodiazepine dependence could be prevented by adherence to recommendations for short-term prescribing (2-4 weeks only when possible). Withdrawal of benzodiazepines from dependent patients is feasible and need not be traumatic if judiciously, and often individually, managed.

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    • "These medications, especially BZD, are sometimes associated with adverse effects and are not suitable for long-term use due to an increased risk of life-threatening multiple drug overdoses. In opiate-dependent patients, the misuse and abuse of BZD is a public health problem because methadone and BZD both have sedating effects on the central nervous system, which lead to difficulty in breathing as well as cognitive impairment [27] [28]. A recent survey revealed a 47% prevalence of lifetime use of BZD among methadonemaintained patients [29] and nonprescribed BZD use among MMT patients ranged from 44 to 66% [30] [31]. "
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    ABSTRACT: Methadone maintenance therapy is an effective treatment for opiate dependence, but more than three-quarters of persons receiving the treatment report sleep quality disturbances. In this double-blind, randomized, controlled trial, we recruited 90 individuals receiving methadone for at least one month who reported sleep disturbances and had Pittsburgh Sleep Quality Index (PSQI) scores > 5. The purpose of this study was to determine whether Suan Zao Ren Tang, one of the most commonly prescribed traditional Chinese medications for treatment of insomnia, improves subjective sleep among methadone-maintained persons with disturbed sleep quality. Ninety patients were randomly assigned to intervention group (n = 45) and placebo group (n = 45), and all participants were analyzed. Compared with placebo treatment, Suan Zao Ren Tang treatment for four weeks produced a statistically significant improvement in the mean total PSQI scores (P = 0.007) and average sleep efficiency (P = 0.017). All adverse events (e.g., lethargy, diarrhea, and dizziness) were mild in severity. Suan Zao Ren Tang is effective for improving sleep quality and sleep efficiency among methadone-maintained patients with sleep complaints.
    Evidence-based Complementary and Alternative Medicine 09/2015; 2015:710895. DOI:10.1155/2015/710895 · 1.88 Impact Factor
    • "The chronic use of benzodiazepines may decrease the efficacy of GABA A receptors, which contributes to the development of tolerance , and abrupt discontinuation may cause a withdrawal syndrome characterized by intense anxiety, agitation and insomnia, memory and concentration impairments, among other symptoms [5]. This withdrawal is frequent with an incidence reported between 30 and 100% in different studies [8] and with potential high severity . The non-prescribed use of benzodiazepines can be associated with the use of illicit drugs and alcohol. "
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    ABSTRACT: There is a high rate of benzodiazepine use in the population. Benzodiazepines are used for multiple indications (anxiety, seizures, alcohol withdrawal, muscular relaxation and anesthesia). Benzodiazepines are also addictive substances and a non-negligible fraction of regular users will develop dependence. There is currently no approved pharmacotherapy for benzodiazepine use disorder treatment and optimal strategies for treatment are unclear. In this review, we aimed to summarize the findings on off-label pharmacologic therapy that have been used for BZD dependence. One classical approach consists at providing a slow taper associated with counseling. Anti-epileptic drugs appear also to alleviate symptoms of withdrawal. The long-term strategies of maintenance therapy (with benzodiazepine) or of blocking therapy (with a GABA antagonist such as flumazenil) could provide some clinical benefit but have not yet been tested appropriately. Pregabalin appears promising and deserves further investigation. There is a clear need for more clinical trials in this area to improve care.
    Current pharmaceutical design 06/2015; 21(23). DOI:10.2174/1381612821666150619092039 · 3.45 Impact Factor
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    • "The second issue that has not yet been clarified in experimental designs using healthy young volunteers is whether residual effects of hypnotics are still present in insomniacs who chronically use hypnotics. Although it is not recommended to use hypnotics for periods longer than 4 weeks, a majority of insomnia patients are treated for prolonged periods (Ashton 2005; Paterniti et al. 2002). This may induce the development of tolerance to the residual effects of hypnotics (Bateson 2002). "
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    ABSTRACT: Many older adults report sleep problems and use of hypnotics. Several studies have shown that hypnotics can have acute adverse effects on driving the next morning. It is unclear however whether driving of chronic hypnotic users is impaired. Therapeutic effects on insomnia and development of tolerance may reduce the residual effects on driving. The present study aimed to compare actual driving performance and driving-related skills of chronic hypnotic users to good sleepers. To determine whether insomnia itself affects driving performance, driving and driving-related skills were compared between insomnia patients who do not or infrequently use hypnotics and good sleepers. Twenty-two frequent users of hypnotics (using hypnotics ≥4 nights per week for more than 3 months), 20 infrequent users (using hypnotics ≤3 nights per week), and 21 healthy, age-matched controls participated in this study. On the night before testing, all subjects were hospitalized for an 8-h sleep recorded by polysomnography. Frequent hypnotic users used their regular medication at bedtime (2330 hours), while infrequent users and controls received no medication. Cognitive performance (word learning, digit span, tracking, divided attention, vigilance, and inhibitory control) was assessed 8.5 h and driving performance between 10 and 11 h after bedtime and dosing. Polysomnographic recordings did not significantly differ between the groups, but the insomnia patients, treated or untreated, still reported subjective sleep complaints. Results show no differences in driving performance and driving-related skills between both groups of insomnia patients and controls. Driving performance in chronic users of hypnotics and untreated insomnia patients is not impaired. For chronic users, this may be due to prescription of relatively safe drugs and low doses. For untreated insomniacs, this corroborates previous findings showing an absence of neuropsychological deficits in this group of patients.
    Psychopharmacology 02/2014; 231(14). DOI:10.1007/s00213-014-3455-z · 3.88 Impact Factor
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