BZs As Instruments of Suicide

Some of the tricyclic antidepressants and barbiturates are probably more lethal than BZs taken alone. But when BZs are combined with other drugs, such as alcohol, their lethality is increased. Overall, the BZs account for many more suicides than most physicians probably realize. 

A survey in Britain covering the decade of the 1980s demonstrated large numbers of successful suicides using BZs, either alone or in combination with alcohol (Serfaty et al., 1993 see also Buckley et al., 1995). Serfaty and Masterton (1993) found 891 fatalities with BZs alone and 591 in combination with alcohol. The total of all poisonings attributed to BZs was 1,576 during the 10-year period, putting them ahead of aspirin/ salicylates at 1,308 as well as amitriptyline (1,083) and dothiepin at 981. 

Among the BZs, two commonly prescribed for sleep, flurazepam (Dalmane) and temazepam (Restoril), had the most deaths per million prescriptions (15.0 and 11.9, respectively). They were more dangerous than about half the antidepressants surveyed by the same methods. Triazolam (Halcion) had far fewer deaths per million prescriptions (5.1) than Dalmane or Restoril, but it was still above the mean for anxiolytic BZs (3.2). 

In estimated deaths per million patients, the rank order among all BZs in Britain was dominated by the hypnotics. Dalmane (90 per million) was first, Restoril (71) was second, the British hypnotic flunitrazepam (Rohypnol 49) was third, and Halcion (30) was fourth. Another British hypnotic, nitrazepam (Mogadon and others 26) was fifth. 

In deaths per million patients, among the antianxiety drugs, praz-epam (Centrax 25) and alprazolam (Xanax 24) were close behind triazolam and nitrazepam. 

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