The most effective treatment for benzodiazepine use disorder is to gradually reduce how much of the drug you use under the supervision of a medical professional. You can do this in a treatment facility or hospital, or at home with the help of your doctor. The clinical manifestations of benzodiazepine poisoning are often more severe in older individuals, frequently leading to coma and increased incidence of complications and longer hospital stays (13).
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.
Study Population
Synthetic benzodiazepines, sometimes called “street,” “designer,” or “novel” benzos, are classified as schedule I. Benzodiazepines are a controlled substance, which means it’s illegal to have them without a doctor’s prescription. Legally manufactured forms of benzodiazepine are classified as schedule IV drugs in the U.S. Figure 3 Subgroup analysis of the effect of BZD abuse and regular use on mini mental state examination in the elderly.
- In the future, more research attention could be dedicated to poisoning resulting from the use of benzodiazepines in conjunction with other common medications frequently taken by the elderly (eg, medications for blood pressure, cholesterol, diabetes, etc.).
- Two reviewers (LL and JL) independently scanned the references by title/abstract to exclude irrelevant articles, then read the full text to identify the appropriate studies based on the above inclusion criteria.
- They are prescribed for a wide range of conditions, which include insomnia, agitation, anxiety and convulsions 19.
- Much like other prescription drugs (e.g., opioids, stimulants) (McHugh et al., 2015), benzodiazepines are most commonly misused for reasons aligned with the drug’s indication (e.g., sleep, anxiety).
- Benzodiazepines used in large quantities can also result in a dopamine rush, which is responsible for creating a sense of pleasure and reward 20.
Toxicity of benzodiazepines in the treatment of insomnia disorders in older adults: a systematic literature review
Similarly, in a small double-blind study of 14 inpatients with a history of benzodiazepine dependence who were undergoing benzodiazepine withdrawal, alprazolam was preferred to equipotent doses of diazepam in a drug choice test (Apelt et al., 1990). CDC prescription death rate data reveal that between 2003 and 2009, alprazolam had the highest death rate increase of all benzodiazepines and second highest overall at 234%, compared with 168% for benzodiazepines as a class (CDC, 2011). The growth in adverse outcomes suggests benzodiazepine prescribing and misuse have increased in tandem, but less is known about benzodiazepine misuse in the U.S.
For NSDUH respondents who misused tranquilizers in the past month, the average frequency of misuse was 5 days, with over 50% of respondents reporting 1–2 days of misuse (CBHSQ, 2018b). However, the frequency of benzodiazepine misuse varies widely with study sample and time frame assessed. Most college students with past-year benzodiazepine misuse report misuse on fewer than five occasions in the previous year (Messina et al., 2016; Pickover et al., 2016).
Characteristics of misuse among younger and older adults
NSDUH is cross-sectional and, due to the 2015 redesign, we cannot track trends in misuse over time. NSDUH response rates have been declining, though this is unfortunately true for several federally-administered national surveys (47). NSDUH is nationally-representative, but of the civilian population and therefore does not include active-duty members of the military or institutionalized adults. We included past-year alcohol, marijuana, and heroin use or abuse/dependence; past-year use of tobacco products; and past-year prescription use, misuse, or abuse/dependence of prescription opioids and stimulants. NSDUH was redesigned in 2015 to collect more detailed information on the use and misuse of prescription medications, including benzodiazepines—in prior years, questions were limited to misuse exclusively (25). The pre-2015 NSDUH definition of misuse was limited to “nonmedical use”, but the 2015 definition was revised to include “in any way a doctor did not direct.” This analysis is limited to the 2015 and 2016 survey years, the years available post-redesign.
A systematic review of interventions to deprescribe benzodiazepines and other hypnotics among older people
Further research could involve reviewing the remaining databases and investigating the poisoning or ingestion of excessive doses among the elderly. In the future, more research attention could be dedicated to poisoning resulting from the use of benzodiazepines in conjunction with other common medications frequently taken by the elderly (eg, medications for blood pressure, cholesterol, diabetes, etc.). Studies primarily reported on the concurrent use of benzodiazepines, benzodiazepine-related medications, and opioids (14-16,20,21). Studies reporting on the average intake of medications in the elderly indicated, for example, the simultaneous use of two different medications (23) or an average of 5.6 different medications (20).
- Retrospective studies evaluating pregnancy outcomes of women exposed to alprazolam during the first trimester of pregnancy found conflicting results of congenital anomalies (Iqbal et al., 2002).
- People with SUDs in the U.S. have rates of benzodiazepine misuse 3.5 to 24 times higher than the general population (Votaw et al., 2019), and the misuse of other substances is the most consistent and robust correlate of benzodiazepine misuse.
- To our knowledge, there are no systematic reviews with a meta-analysis that summarizes the current status of the cognitive effect of BZD use and abuse in the elderly population.
BMC Public Health
In 1955, the first benzodiazepine (BZD), chlordiazepoxide, was developed, followed by diazepam in 1963 8-11. In 1957, as an alternative to previous barbiturates, BZD use started to gradually replace the opiate derivates 12. Benzodiazepines became widely used drugs because of their potential benefits and were the most abused drugs by the 1970s 13. With growing concern about the abuse of BZDs, they were placed on Food and Drug Administration drug list 14. The risk of BZD dependence was officially recognized by the American Psychiatric Association in 1990 15,16.
In Spain, a telephone survey was conducted by the health professionals among the Drug Addiction Assistance of Castile and Leon (DAACYL) units. The professionals in the DAACYL units expressed that the clinical impact during the first six weeks of the pandemic was moderate; however, six centers reported that patients increased or started consuming alcohol and benzodiazepines, especially alprazolam 62. Among people who were confirmed with coronavirus infection and discharged subsequently, there was a 3.3% initiation of new benzodiazepine prescriptions 63. They include long-acting diazepam, chlordiazepoxide, flurazepam, and clorazepate along with intermediate-acting alprazolam, clonazepam, lorazepam, oxazepam, and temazepam benzodiazepine use, misuse, and abuse: a review 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.
Benzodiazepines: Uses, Dangers, and Clinical Considerations
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. Many medications have been tested to alleviate withdrawal symptoms and make it easier for patients to discontinue BZD since a gradual taper does not always lead to successful discontinuation of the drug. Currently, a gradual taper with clonazepam is used as maintenance therapy for BZD-dependent patients. However, it still carries the risk for abuse and dependence since this is also a BZD, albeit a slow-acting one 67.
