Chlordiazepoxide abuse

The benzodiazepines currently available for clinical use vary substantially in pharmacokinetics, acute euphoriant effects, and frequency of reported dependence. It is likely, therefore, than not all benzodiazepines have the same potential for abuse. Diazepam, lorazepam, and alprazolam may have greater abuse potential than chlordiazepoxide and clorazepate (Wolf et al. 1990). Similarly, oxazepam has been reported to produce low levels of abuse (Eliding 1978). Jaffe et al. (1983) found that in recently detoxified alcoholic patients, halazepam produces minimal euphoria even at a supratherapeutic dosage. The development of partial agonist and mixed agonist/antagonist compounds at the benzodiazepine receptor complex may offer an advantage over approved benzodiazepines for use in alcoholic patients. 

Agents with rapid onset of action (e.g., diazepam, alprazolam) have higher abuse potential because of their reinforcing effects. Chlordiazepoxide or oxazepam are less likely to be abused. 

The withdrawal syndrome from ethanol includes anxiety, insomnia, possibly convulsions and visual hallucinations (delirium tremens - the Dts). It is treated or better still prevented by a calm environment, adequate (but not excessive) hydration, and careful monitoring, with the added use of anticon-vulsive/sedative agents, mainly benzodiazepines to prevent or treat convulsions. The preventive effects of benzodiazepines on withdrawal morbidity has been clearly demonstrated. There do not seem to be major differences between benzodiazepines, such as chlordiazepoxide or diazepam or others. Because of the abuse potential in these highly susceptible patients, these should be rapidly weaned, and proper prevention of relapse instituted. Other drugs such as meprobamate and clomethiazole (Hemineurin) are commonly used in some countries. The effectiveness... 

The CNS depressants include barbiturates, nonbarbiturate sedatives, and the benzodiazepines. As the medical use of barbiturates decreased, primarily because of their high addiction liability and the danger of acute lethality, the use of the benzodiazepine anxiolytics increased. The most commonly abused barbiturates are secobarbital, pentobarbital, and amobarbital. Pheno-barbital is not generally abused, because of its slow onset of action. The most commonly abused anxiolytics include diazepam, chlordiazepoxide, midazolam, lo-razepam, and flurazepam. These drugs are readily attainable from illicit sources. 

Schedule IV Low risk for abuse. Can lead to psychological dependency. Can be used for medicinal purpose. Includes chlordiazepoxide (Librium), benzodiazepines, and propoxyphene (Darvon). 

The anxiolytic effects of lorazepam and possibly chlordiazepoxide may be opposed by alcohol. Alprazolam and alcohol together may possibly increase behavioural aggression. Similarly, flunitrazepam abuse can cause violent behaviour, impulsive decision-making and anterograde amnesia a report looking at violent crimes committed by abusers of flunitrazepam found that alcohol was almost always also present. Alcoholic drinks also enhance the effects of flunitrazepam when it is used as a date rape drug. ... 

Note that the top 25 detected by NFLIS are all among the most commonly abused drags in the United States. The major ones missing (but which are captured in the remaining 10% of samples analyzed by NFLIS) are baibiturates (e.g., seconal and phenobaibital, but whose rate of abuse has been declining), certain benzodiazepines (except flunitrazepam, such as alprazolam, diazepam, and chlordiazepoxide). 

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