Accordingly, women might particularly benefit from efforts to reduce benzodiazepine misuse and related harms that target negative affect. Oral route of administration, or swallowing a pill, is by far the most common route of administration (Brandt et al., 2014a; McLarnon et al., 2014; Pauly et al., 2012). Intranasal benzodiazepine misuse is the second most common route of administration, with approximately 10% of college students (Brandt et al., 2014a) and 45% of young adults with recent prescription drug misuse (Lankenau et al., 2012a) reporting lifetime intranasal use. Smoking and injecting benzodiazepines are both relatively uncommon and have primarily been documented in samples with SUDs or severe patterns of substance use (e.g., injection heroin use). Even in these populations, the prevalence of smoking benzodiazepines is low (i.e., 3–7%) (Lankenau et al., 2012a; Navaratnam and Foong, 1990; Vogel et al., 2013).
Benzodiazepine Abuse Causes
This is consistent with findings that regulating negative affective and somatic states is the most common motive for benzodiazepine misuse. Yet, it is unclear if psychiatric distress is an antecedent or consequence of benzodiazepine misuse (or both), and findings from the reviewed studies provide partial support for both explanations. It is likely that greater psychiatric distress motivates misuse to relieve symptoms, and symptoms of psychiatric distress are also a consequence of acute or protracted benzodiazepine withdrawal. The association between psychiatric distress and benzodiazepine misuse underscores the importance of first considering non-benzodiazepine treatments (e.g., cognitive-behavioral therapy, antidepressants) for psychiatric symptoms among those who are most likely to misuse benzodiazepines. Women are more likely to report misusing benzodiazepines to cope with negative affect, and associations between psychiatric distress and benzodiazepine misuse appear to be stronger in women than in men.
3. Misuse of Benzodiazepine
For example, several studies controlling for history of a benzodiazepine prescription have identified higher misuse rates (Fenton et al., 2010; Maust et al., 2018) and higher likelihood of developing a use disorder among men (Lev-Ran et al., 2013). These findings illustrate that gender differences in misuse might vary according to prescription status and age. Nevertheless, the comparable prevalence between men and women in the U.S. and higher rates of misuse among women outside of the U.S. is in contrast to many other substances (e.g., heroin, marijuana), for which prevalence is generally higher in men (CBHSQ, 2018b).
Learn More About Commonly Misused Drugs
Although prevalence estimates for misuse of specific benzodiazepine formulations appear to coincide with prescribing rates, certain benzodiazepines are more preferred than others, potentially reflecting higher abuse liability. However, these studies were published over two decades ago, and therefore preference might—at least in part—reflect availability during this period. Recent studies from East Asia also report midazolam injection (Hayashi et al., 2013; Kerr et al., 2010; Ti et al., 2014; Van Griensven et al., 2005).
Stabilisation and maintenance therapy
Careful medication management by health care professionals can reduce the increased risk of serious side effects. They include long-acting diazepam, chlordiazepoxide, flurazepam, and clorazepate along with intermediate-acting alprazolam, clonazepam, lorazepam, oxazepam, and temazepam with short-acting agents being midazolam and triazolam. BZDs are metabolized oxidatively in the liver by the cytochrome P450 enzymes (phase I), conjugated with glucuronide (phase II), and excreted almost entirely in the urine [18]. They are prescribed for a wide range of conditions, which include insomnia, agitation, anxiety and convulsions [19].
We described study findings in this manner to balance accuracy with interpretability; however, it is unknown how the inclusion of other sedatives and tranquilizers in the reviewed literature impacted results. We also chose to include studies among those with SUDs that defined benzodiazepine misuse based on urine drug screen results, as opposed to clear definitions of misuse. Although these studies suggest, or imply, that this constitutes problematic use, these studies may have included participants who were using benzodiazepines as prescribed. In particular, the majority of the literature on preferences for specific benzodiazepine formulations was published over two decades ago, thus limiting strong conclusions about reasons for preferring specific benzodiazepine formulations. Lastly, prevalence estimates primarily reflect data collected in the U.S., though 49% of studies included in the present review were conducted in countries outside of the U.S.
- Benzodiazepines may have a high potential for abuse and misuse during the pandemic [43], and they are typically co-abused in patients with substance use disorders [44].
- However, patients or others using these medications are unlikely to report directly to FDA about abuse or illicit uses.
- Care should be taken in interpreting the results as some metabolites are themselves parent compounds.
- Anticonvulsants have some efficacy in benzodiazepine withdrawal if the patient is not dependent on other drugs.
Low-risk patients can be managed in general practice and may benefit most from attempting withdrawal. High-risk patients are best managed with initial stabilisation and maintenance therapy in specialist residential severe benzodiazepine withdrawal syndrome or outpatient addiction services. Your healthcare provider will ask when you take benzodiazepines, and how much you take. Blood or urine tests may be used to check the level of benzodiazepines in your system.
Benzodiazepine Overuse Pathology, Misuses, and Complications
- The subjects were interviewed with surgery-based consultations for approximately 10 min [12].
- Yet, the prevalence of lifetime and past-year tranquilizer misuse increased among this age group from 2002–2003 to 2012–2013 (from 4.5% to 6.6% and 0.6% and 0.9%, respectively; Schepis and McCabe, 2016).
- 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.
- More studies need to be performed on treating withdrawal with propranolol, including testing it as a potential adjunct to tapering off both long-acting and short-acting BZD.
- This should be accompanied by well resourced campaigns to educate the public about the risks of inappropriate benzodiazepine use.
Secondly, approximately 20% of the children in the intensive care unit given BZD during sedation, more specifically midazolam, have been shown to exhibit withdrawal effects. The severity of the withdrawal sequelae depends on the total dose and duration of infusion and usually presents as agitation, tremors, difficulty sleeping, and inconsolable crying [60]. Results showed that, compared to wild-type mice, mice on diazepam experienced longer uninterrupted sleep [42]. It also reduces the expression of mRNA transcripts such as CaMKIIa, BDNF, GIF, c-fos, NGFIa which are necessary for regulating synapses and plasticity [42].
2. Pharmacologic Management of Withdrawal Symptoms
