Benzodiazepine Use Disorder: Common Questions and Answers
Some studies in the past have shown that there is a correlation between chronic BZD use and a decline in cognitive function, including the development of dementia and dementia-like diseases. One study showed a potential for cognitive decline after BZD use in the elderly, but at the same time did not find a link between their use and the development of Alzheimer’s dementia [73]. The researchers in the study cautioned the prescription of BZD in the elderly due to the potential for cognitive decline [73]. One of the main categories of people with BZD prescriptions is those with insomnia. Manconi et al. explored the effects of long-term BZD use on sleep architecture and microstructure in those with insomnia.
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They found significant changes in sleep microstructure in chronic insomnia with high dosage abuse of BZD, but sleep architecture changes were not significant. Long-term use of BZD leads to negative changes in sleep microstructure in patients with insomnia [35]. Given their lipid solubility, BZDs have a high volume of distribution in the body, which translates to higher tissue concentrations than blood. After exerting their effect, BZDs are metabolized primarily by the liver and excreted by conjugation, so they should be used in caution in the elderly, smokers, and those with liver disease or damage [3]. Due to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS pathology, muscle relaxation, and epilepsy. Their sedative effect aids in sleep and insomnia disorders by reducing sleep onset latency.
- Patients can live at home and resume day-to-day responsibilities, such as house chores or employment, or they can live with family or friends in a supportive environment.
- One study showed that replacing BZD with a 45 day captodiamine led to a decrease in severity of withdrawal symptoms in patients taking BZD for six months [70].
- Provide symptomatic treatment (see Table 3) and supportive care as required.
- Consider a stepped approach, starting with minimal interventions such as advisory letters before progressing to more intense methods.
- However, it still carries the risk for abuse and dependence since this is also a BZD, albeit a slow-acting one [67].
Be aware of subtle behaviours in patients with low-dose dependence
Due to its short half-life, and rapid absorption, alprazolam is distinguished as one of the most rapid-acting BZD with fastest relief of symptomology, increasing its abuse liability [54]. Alprazolam is widely used as monotherapy for panic disorder and anxiety and was found severe benzodiazepine withdrawal syndrome superior to other forms of monotherapy for these conditions including other BZD, non-SSRI antidepressants, and buspirone. This superior effect is thought to be due to its unique alpha-2 adrenergic activity, enhancing its potency for relieving panic and anxiety disorders.
2. Pharmacologic Management of Withdrawal Symptoms
Patients should be monitored regularly (3-4 times daily) for symptoms and complications. The Short Opioid Withdrawal Scale (SOWS, p.37) is a useful tool for monitoring withdrawal. During withdrawal some patients may become disruptive and difficult to manage. The patient may be scared of being in the closed setting, or may not understand why they are in the closed setting. In the first instance, use behaviour management strategies to address difficult behaviour (Table 2). Physical exercise may prolong withdrawal and make withdrawal symptoms worse.
- It should include the indication for prescribing, dose, duration of use, age and any history of psychiatric or medical comorbidity as well as any other past or current substance misuse.
- As cannabis withdrawal is usually mild, no withdrawal scales are required for its management.
- A rebound effect is defined as a withdrawal symptom that was the original reason for taking the drug.
2. STANDARD CARE FOR WITHDRAWAL MANAGEMENT
Patients should be observed every three to four hours to assess for complications such as worsening anxiety and dissociation, which may require medication. For up to a month after ceasing inhalant use, the patient may experience confusion and have difficulty concentrating. This should be taken into consideration in planning treatment involvement. A minority of patients withdrawing from stimulants may become significantly distressed or agitated, presenting a danger to themselves or others.
At The Recovery Village, patients can rely on trained staff to properly medicate if needed, and monitor withdrawal symptoms in a safe and comfortable environment. Researchers investigating the correlation between anxiolytic and hypnotic drugs with mortality hazards examined over 100,000 patients in a retrospective cohort study. They found that the hazard of death was doubled in patients prescribed BZD compared to control patients [47]. There was an association between the prescription of anxiolytic drugs and mortality, resulting in 4 excess deaths in the anxiolytic drug group within an average of 7.6 years [47]. The relationship between hypnotics and cancer was expanded upon by Kripke et al. They found a 35% increased chance of developing a new non-melanoma cancer in users of hypnotics [48].
Side Effects of Benzodiazepines
