Abuse liability history

Benzodiazepines have a low risk for abuse in anxiety disorder patients without a history of alcohol or other substance abuse. Among the benzodiazepines there may be a spectrum of abuse liability, with drugs that serve as prodrugs for desmethyldiazepam (e.g., clorazepate), slow-onset agents (e.g., oxazepam), and partial agonists (e.g., abecarnil) having the least potential for abuse. However, there is no currently marketed benzodiazepine or related drug that is free of potential for abuse. 

Benzodiazepines are safe and remarkably well tolerated. The most common side effect is drowsiness. However, elderly patients may experience confusion and a lack of coordination that increases the risk of falls. The benzodiazepines are not without abuse liability and should be used sparingly in patients with a history of a substance use disorder. 

Drug abuse and dependence In a study of abuse liability conducted in individuals with known histories of benzodiazepine abuse, doses of eszopiclone 6 and 12 mg produced euphoric effects similar to those of diazepam 20 mg. 

For centuries opium was used for both medicinal and recreational purposes. Derived from the poppy Papaver somniferum, it contains numerous opiates, the primary one of which is morphine. The term opiate has largely been replaced by opioid, which represents all compounds with morphinelike activity and includes morphine, morphine derivatives, and peptides. Opiate is used to refer to morphinelike drugs derived from the plant and structurally similar analogues. These drugs are frequently referred to as narcotics, a Greek term for stupor, which is scientifically obsolete. Even in its early history, opium presented a problem when it was smoked or taken orally. The introduction of the hypodermic needle and syringe, however, drastically enhanced the euphoric properties of opioids and thereby altered their abuse liability. In addition, the synthesis of heroin resulted in an opioid that was more potent than morphine and ideally suited for intravenous administration. 

An additional psychotropic medication that may be worth considering specifically for GAD is buspirone. One major benefit of buspirone can be found in the virtual absence of dependence and abuse liability. Although it is not effective for the acute relief of anxiety or panic disorders (anxiolytic effects may take up to a week to be established), buspirone may be indicated for patients with a history of alcohol abuse or among those who fear physiologic and psychological dependence with benzodiazepines. 

The abuse liability of a drug is enhanced by rapidity of onset because effects that occur soon after administration are more likely to initiate the chain of events that leads to loss of control over drug taking. The history of cocaine use illustrates the changes in abuse liability of the same compound, depending on the form and the route of administration e.g., crack cocaine). 

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