Benzodiazepine use disorder

Benzodiazepine use disorder
Other namesBenzodiazepine drug misuse
SpecialtyAddiction Medicine, Psychiatry
Benzodiazepines
Chemical structure diagram of a benzene ring fused to a diazepine ring. Another benzene ring is attached to the bottom of the diazepine ring via a single line. Attached to the first benzene ring is a side chain labeled R7; to the second, a side chain labeled R2'; and attached to the diazepine ring, two side chains labeled R1 and R2.
The core structure of benzodiazepines. "R" labels denote common locations of side chains, which give different benzodiazepines their unique properties.

Benzodiazepine use disorder (BUD), also called misuse or abuse,[1] is the use of benzodiazepines without a prescription and/or for recreational purposes, which poses risks of dependence, withdrawal and other long-term effects.[2][3] Benzodiazepines are one of the more common prescription drugs used recreationally. When used recreationally benzodiazepines are usually administered orally but sometimes they are taken intranasally or intravenously. Recreational use produces effects similar to alcohol intoxication.[3][4]

In tests in pentobarbital-trained rhesus monkeys benzodiazepines produced effects similar to barbiturates.[5] In a 1991 study, triazolam had the highest self-administration rate in cocaine-trained baboons, among the five benzodiazepines examined: alprazolam, bromazepam, chlordiazepoxide, lorazepam, triazolam.[6] A 1985 study found that triazolam and temazepam maintained higher rates of self-injection in both human and animal subjects compared to a variety of other benzodiazepines (others examined: diazepam, lorazepam, oxazepam, flurazepam, alprazolam, chlordiazepoxide, clonazepam, nitrazepam, flunitrazepam, bromazepam, and clorazepate).[7] A 1991 study indicated that diazepam, in particular, had a greater abuse liability among people who were drug abusers than did many of the other benzodiazepines. Some of the available data also suggested that lorazepam and alprazolam are more diazepam-like in having relatively high abuse liability, while oxazepam, halazepam, and possibly chlordiazepoxide, are relatively low in this regard.[8] A 1991–1993 British study found that the hypnotics flurazepam and temazepam were more toxic than average benzodiazepines in overdose.[9] A 1995 study found that temazepam is more rapidly absorbed and oxazepam is more slowly absorbed than most other benzodiazepines.[10] Benzodiazepines have been abused both orally and intravenously. Different benzodiazepines have different abuse potential; the more rapid the increase in the plasma level following ingestion, the greater the intoxicating effect and the more open to abuse the drug becomes. The speed of onset of action of a particular benzodiazepine correlates well with the 'popularity' of that drug for abuse. The two most common reasons for preference were that a benzodiazepine was 'strong' and that it gave a good 'high'.[11]

According to Dr. Chris Ford, former clinical director of Substance Misuse Management in General Practice, among drugs of abuse, benzodiazepines are often seen as the 'bad guys' by drug and alcohol workers. Illicit users of benzodiazepines have been found to take higher methadone doses, as well as showing more HIV/HCV risk-taking behavior, greater poly-drug use, higher levels of psychopathology and social dysfunction. However, there is only limited research into the adverse effects of benzodiazepines in drug misusers and further research is needed to demonstrate whether this is the result of cause or effect.[12]

  1. ^ "Benzodiazepine dependence: reduce the risk". NPS MedicineWise. Archived from the original on 23 July 2015. Retrieved 23 July 2015.
  2. ^ Tyrer, P.; Silk, K. R., eds. (2008). "Treatment of Sedative-Hypnotic Dependence". Cambridge Textbook of Effective Treatments in Psychiatry (1st ed.). Cambridge University Press. p. 402. ISBN 978-0-521-84228-0.
  3. ^ a b Griffiths, R. R.; Johnson, M. W. (2005). "Relative Abuse Liability of Hypnotic Drugs: A Conceptual Framework and Algorithm for Differentiating among Compounds" (PDF). Journal of Clinical Psychiatry. 66 (Suppl 9): 31–41. PMID 16336040. Archived from the original (PDF) on 2 October 2018. Retrieved 25 May 2009.
  4. ^ Sheehan, M. F.; Sheehan, D. V.; Torres, A.; Coppola, A.; Francis, E. (1991). "Snorting Benzodiazepines". The American Journal of Drug and Alcohol Abuse. 17 (4): 457–468. doi:10.3109/00952999109001605. PMID 1684083.
  5. ^ Woolverton, W. L.; Nader, M. A. (December 1995). "Effects of several benzodiazepines, alone and in combination with flumazenil, in rhesus monkeys trained to discriminate pentobarbital from saline". Psychopharmacology. 122 (3): 230–236. doi:10.1007/BF02246544. PMID 8748392. S2CID 24836734.
  6. ^ Griffiths, R. R.; Lamb, R. J.; Sannerud, C. A.; Ator, N. A.; Brady, J. V. (1991). "Self-Injection of Barbiturates, Benzodiazepines and other Sedative-Anxiolytics in Baboons". Psychopharmacology. 103 (2): 154–161. doi:10.1007/BF02244196. PMID 1674158. S2CID 30449419.
  7. ^ GRIFFITHS, Roland R.; RICHARD J. LAMB; NANCY A. ATOR; JOHN D. ROACHE; JOSEPH V. BRADY (1985). "Relative Abuse Liability of Triazolam: Experimental Assessment in Animals and Humans" (PDF). Neuroscience & Biobehavioral Reviews. 9 (1): 133–151. CiteSeerX 10.1.1.410.6027. doi:10.1016/0149-7634(85)90039-9. PMID 2858078. S2CID 17366074. Archived from the original (PDF) on 12 March 2013. Retrieved 18 August 2012.
  8. ^ Griffiths, R. R.; Wolf, B. (August 1990). "Relative Abuse Liability of different Benzodiazepines in Drug Abusers". Journal of Clinical Psychopharmacology. 10 (4): 237–243. doi:10.1097/00004714-199008000-00002. PMID 1981067. S2CID 28209526.
  9. ^ Serfaty, M.; Masterton, G. (September 1993). "Fatal poisonings attributed to benzodiazepines in Britain during the 1980s". British Journal of Psychiatry. 163 (3): 386–393. doi:10.1192/bjp.163.3.386. PMID 8104653. S2CID 46001278.
  10. ^ Buckley, N. A.; Dawson, A. H.; Whyte, I. M.; O'Connell, D. L. (1995). "Relative toxicity of benzodiazepines in overdose". British Medical Journal. 310 (6974): 219–21. doi:10.1136/bmj.310.6974.219. PMC 2548618. PMID 7866122.
  11. ^ Australian Government; Medical Board (2006). "ACT MEDICAL BOARD – STANDARDS STATEMENT – PRESCRIBING OF BENZODIAZEPINES" (PDF). Australia: ACT medical board. Archived from the original (PDF) on 4 April 2011. Retrieved 13 September 2011.
  12. ^ Chris Ford (2009). "What is possible with benzodiazepines". UK: Exchange Supplies, 2009 National Drug Treatment Conference. Archived from the original on 1 May 2010.