Benzodiazepine use disorder
[3][4] In tests in pentobarbital-trained rhesus monkeys benzodiazepines produced effects similar to barbiturates.
[6] A 1985 study found that triazolam and temazepam maintained higher rates of self-injection in both human and animal subjects compared to a variety of other benzodiazepines (others examined: diazepam, lorazepam, oxazepam, flurazepam, alprazolam, chlordiazepoxide, clonazepam, nitrazepam, flunitrazepam, bromazepam, and clorazepate).
[8] A 1991–1993 British study found that the hypnotics flurazepam and temazepam were more toxic than average benzodiazepines in overdose.
[17] Tolerance leads to a reduction in GABA receptors and function; when benzodiazepines are reduced or stopped this leads to an unmasking of these compensatory changes in the nervous system with the appearance of physical and mental withdrawal effects such as anxiety, insomnia, autonomic hyperactivity and possibly seizures.
[18] Include the following:[14] All sedative-hypnotics, e.g. alcohol, barbiturates, benzodiazepines and Z-drugs have a similar mechanism of action, working on the GABAA receptor complex and are cross tolerant with each other and also have abuse potential.
Use of prescription sedative-hypnotics—for example, the nonbenzodiazepine Z-drugs—often leads to a relapse back into substance misuse with one author stating this occurs in over a quarter of those who have achieved abstinence.
Abuse of benzodiazepines occurs in a wide age range of people and includes teenagers and the old.
[22] Complications of benzodiazepine abuse include drug-related deaths due to overdose especially in combination with other depressant drugs such as opioids.
Injection of the drug carries risk of: thrombophlebitis, deep vein thrombosis, deep and superficial abscesses, pulmonary microembolism, rhabdomyolysis, tissue necrosis, gangrene requiring amputation, hepatitis B and C, as well as blood borne infections such as HIV infection (caused by sharing injecting equipment).
[14] Long-term use of benzodiazepines can worsen pre-existing depression and anxiety and may potentially also cause dementia with impairments in recent and remote memory functions.
It has been concluded in various studies that benzodiazepine use causes greater levels of risk and psycho-social dysfunction among drug misusers.
Polydrug use involving benzodiazepines and alcohol can result in blackouts, increased risk-taking behaviour, and in severe cases seizures and overdose.
[27] Several (primary research) studies, even into the last decade, claimed that individuals with a history of familial abuse of alcohol or who are siblings or children of alcoholics appeared to respond differently to benzodiazepines than so called genetically healthy persons, with males experiencing increased euphoric effects and females having exaggerated responses to the adverse effects of benzodiazepines.
These characteristics are chiefly practical ones—most especially, availability (often based on popular perception of 'dangerous' versus 'none dangerous' drugs) through prescribing physicians or illicit distributors.
A short elimination half-life and a rapid onset of action are characteristics which increase the abuse potential of a benzodiazepines.
[18] The following table provides the elimination half-life, approximate equivalent doses, speed of onset of action, and duration of behavioural effects.
These effects may become apparent during continued use or may appear as withdrawal symptoms when dosage is reduced or the drug is stopped.
Particular problems with abuse of temazepam are often related to gel capsules being melted and injected and drug-related deaths.
[37][38][39] Injecting most benzodiazepines is dangerous because of their relative insolubility in water (with the exception of midazolam), leading to potentially serious adverse health consequences for users.
[42] Concentrations of benzodiazepines detected in impaired motor vehicle drivers often exceeding therapeutic doses have been reported in Sweden and in Northern Ireland.
Those who reported using benzodiazepines alone were found to be in the mid-range when compared to other drug using patterns in terms of property crimes and criminal breaches.
[47][48] Serial killer Jeffrey Dahmer admitted to using triazolam (Halcion), and occasionally temazepam (Restoril), in order to sedate his victims prior to murdering them.
[50] Temazepam abuse and seizures have been falling in the UK probably due to its reclassification as Schedule 3 controlled drug with tighter prescribing restrictions and the resultant reduction in availability.
The statistics showed that treatment for benzodiazepines as the main problematic drug had more than doubled from the previous year and was a growing problem in Northern Ireland.
In certain states like Victoria and Queensland, temazepam accounts for most benzodiazepine sought by forgery of prescriptions and through pharmacy burglary.
The more rapid the increase in the plasma level following ingestion, the greater the intoxicating effect and the more open to abuse the drug becomes.
[11] The most frequently abused of the benzodiazepines in both the United States and Canada are alprazolam, clonazepam, lorazepam and diazepam.
