Benzodiazepines abuse

Bleich A, Gelkopf M, Weizman T, et al Benzodiazepine abuse in a methadone maintenance treatment clinic in Israel characteristics and a pharmacotherapeutic approach. Isr J Psychiatry Relat Sci 39 104-112, 2002 Bohn LM, Gainetdinov RR, Lin FT, et al Mu-opioid receptor desensitization by beta-arrestin-2 determines morphine tolerance but not dependence. Nature 408 720— 723, 2000... 

Sporadic use (e.g., for the induction of sleep after a psychostimulant binge) does not require specific detoxification. Sustained use can be treated as described in the previous sections on detoxification from therapeutic or high dosages but with added caution. In mixed opioid and benzodiazepine abuse, the patient should be stabilized with methadone (some clinicians use other oral preparations of opioids) and a benzodiazepine. Buprenorphine should not be administered with benzodiazepines, because a pharmacodynamic interaction is possible (Ibrahim et al. 2000 Kilicarslan and Sellers 2000) and fatalities have been reported with the combination (Reynaud et al. 1998). Sedative-hypnotic withdrawal is the more medically serious procedure, and we usually... 

Busto U, Sellers EM, Naranjo CA, et al Patterns of benzodiazepine abuse and dependence. Br J Addict 81 87—94, 1986b... 

Ciraulo DA, Sands BE, Shader RI Critical review of liability for benzodiazepine abuse among alcoholics. Am J Psychiatry 145 1501-1506, 1988b Ciraulo DA, Barnhill JG, Ciraulo AM, et al Parental alcoholism as a risk factor in benzodiazepine abuse a pilot smdy. Am J Psychiatry 146 1333-1335, 1989 Ciraulo DA, Antal EJ, Smith RB, et al The relationship of alprazolam dose to steady-state plasma concentrations. J Clin Psychopharmacol 10 27—32, 1990 Ciraulo DA, Sarid-Segal O, Knapp C, et al Liability to alprazolam abuse in daughters of alcoholics. Am J Psychiatry 153 956-958, 1996 Ciraulo DA, Barnhill JG, Ciraulo AM, et al Alterations in pharmacodynamics of anxiolytics in abstinent alcoholic men subjective responses, abuse liability, and electroencephalographic effects of alprazolam, diazepam, and buspirone. J Clin Pharmacol 37 64-73, 1997... 

Schmidt LG, Grohmann R, Mttller-Oerlinghausen B, et al Prevalence of benzodiazepine abuse and dependence in psychiatric in-patients with different nosology an assessment of hospital-hased drug surveillance data. Br J Psychiatry 154 839— 843, 1989... 

Williams H, Oyefeso A, Ghodse AH Benzodiazepine misuse and dependence among opiate addicts in treatment. It J Psychol Med 13 62-64, 1996 Wiseman SM, Spencer-Peet J Prescribing for alcoholics a survey of drugs taken prior to admission to an alcoholism unit. Practitioner 229 88—89, 1985 Wolf B, Grohmann R, Biber D, et al Benzodiazepine abuse and dependence in psychiatric inpatients. Pharmacopsychiatry 22 54—60, 1989 Wood MR, Kim JJ, Han W, et al Benzodiazepines as potent and selective bradykinin B1 antagonists. J Med Chem 46 1803—1806, 2003 Zawertailo LA, Busto UE, Kaplan HL, et al Comparative abuse liability and pharmacological effects of meprobamate, triazolam, and butabarbital. J Clin Psycho-pharmacol 23 269-280, 2003... 

Medically Appropriate Use. This is not an issue in the assessment of alcohol or illicit drugs, but can be a consideration when there is suspicion of opiate analgesic or benzodiazepine abuse. Abuse of or dependence on these medications can lead to what is often derogatorily described as drug seeking behavior. The impli-... 

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. 

Benzodiazepines and barbiturates are self-administered by animals (Koob, 1992). Unlike other rewarding drugs, these are not believed to release dopamine from the nucleus accumbens or prefrontal cortex (Nutt, 1996 Di Chiara Im-perato, 1988 Spanagel Weiss, 1999). However, it is possible that they do so when used for euphoric effects in the high dosages used by benzodiazepine abusers (Strang et al., 1993). 

Harrison M, Gusto U, Naranjo CA, et al. Diazepam tapering in detoxification of high-dose benzodiazepine abuse. Clin Pharmacol Ther 1984 36 527-532. 

Busto, U., Sellers, E.M., Naranjo, C.A., Cappell, H.D., Sanchez-Craig, M., and Simpkins, J. (1986) Patterns of benzodiazepine abuse and dependence , British Journal of Addiction, 81 87-94. 

When benzodiazepines are used or abused chronically, they may cause adaptive changes in benzodiazepine receptors such that their power to modulate GABA-A receptors in response to a benzodiazepine decreases with time (Fig. 13—32). These patients may become irritable or anxious or even experience panic attacks if they suddenly stop taking the drugs (Fig. 13—33). This shift in benzodiazepine abusers to a desensitized receptor (Fig. 13—32) may manifest itself as the need to take higher doses of benzodiazepines to get high. This receptor desensitization is most likely to be uncovered once chronic abusive benzodiazepine administration is discontinued, particularly if discontinuation is sudden (Fig. 13-33). This desensitized receptor worsens the impact of benzodiazepine discontinuation because the brain, which is... 

Hospital admissions due to benzodiazepine abuse have been studied as well. According to the Treatment Episode Data Set (TEDS) from the Substance Abuse and Mental Health Services Administration (SAMHSA) of the United States Department of Health and Human Services, tranquilizers such as the benzodiazepines were the primary substance of 0.3% of TEDS admissions in 1998. In addition, 39% of patients admitted for tranquilizer use reported abuse of alcohol as well as tranquilizers. Admissions for tranquilizer abuse were mostly female (48%) and white (90%). 

The personal and social consequences of benzodiazepine abuse have not, to date, been extensively studied. A few seminal studies have shown, however, that use and abuse of the benzodiazepines carry the possibilities of impaired decision-making, decreased learning skills, released aggression, and an impaired ability to empathize, all of which can have profound effects on an individual s educational, social, and workplace environments. 

Schmauss, C. Krieg, J. C. 1987, Enlargement of cerebrospinal fluid spaces in long-term benzodiazepine abusers, Psychol.Med., vol. 17, no. 4, pp. 869-873. 

Trimipramine is a sedating tricyclic antidepressant that has been used as a hypnotic (1) it shares this activity with other drugs of its class, notably amitriptyline, dosulepin, doxepin, and trazodone, and with the tetracyclics mianserin and mirtazapine. Trimipramine may be preferred for this purpose, since it has less effect on sleep architecture, including REM sleep (2), and has only a modest propensity to produce rebound insomnia in a subset of patients (3). Sedative antidepressants may be particularly appropriate for individuals at risk of benzodiazepine abuse and patients with chronic pain (4). The usual pattern of tricyclic adverse effects, especially antimuscarinic and hypotensive effects and weight gain, can be expected. Some authors, enthusiastic about GABA enhancers, contend that antidepressants are not useful hypnotic alternatives (5). 

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