Benzodiazepines Benzodiazepine abuse

Anxiety disorders are common in the population of opioid-addicted individuals however, treatment studies are lacking. It is uncertain whether the frequency of anxiety disorders contributes to high rates of illicit use of benzodiazepines, which is common in methadone maintenance programs (Ross and Darke 2000). Increased toxicity has been observed when benzodiazepines are co-administered with some opioids (Borron et al. 2002 Caplehorn and Drummer 2002). Although there is an interesting report of clonazepam maintenance treatment for methadone maintenance patients who abuse benzodiazepines, further studies are needed (Bleich et al. 2002). Unfortunately, buspirone, which has low abuse liability, was not effective in an anxiety treatment study in opioid-dependent subjects (McRae et al. 2004). Current clinical practice is to prescribe SSRIs or other antidepressants that have antianxiety actions for these patients. Carefully controlled benzodiazepine prescribing is advocated by some practitioners. 

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... 

There is some evidence of a synergistic effect on reinforcement with concurrent administration of benzodiazepines and opioids (Walker and Ettenberg 2003). Cocaine abusers are less likely than opioid abusers to abuse benzodiazepines, preferring alcohol and opioids as secondary drugs of abuse. The most common pattern of benzodiazepine misuse in these individuals is intermittent use of therapeutic or supratherapeutic doses to counter unwanted effects of cocaine. 

Although estimates vary widely, approximately 10%-20% of individuals presenting for treatment of alcohol dependence may be using or abusing benzodiazepines (Ciraulo et al. 1988b Ciraulo et al. 2004 Johansson et al. 2003 ... 

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. 

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