Article

Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry 18: 249-255

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

ABSTRACT

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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    • "After informed consent and baseline examinations, all trial participants were instructed to gradually reduce their usual benzodiazepine dosage (including benzodiazepine-related drugs) at an approximate rate of 10 – 20% every second week. This rate of benzodiazepine tapering has been recommended internationally (Ashton 2005). We aimed for this withdrawal rate as the fi rst steps of tapering. "
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    • "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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