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Lehti V, Salama E, Niemelä S, Tanskanen A, Gissler M, Suvisaari J, Taipale H. Use of benzodiazepine and related drugs in migrants and Finnish-born persons: a nationwide register-based study. Scand J Public Health 2023; 51:1222-1230. [PMID: 35876428 PMCID: PMC10642218 DOI: 10.1177/14034948221112470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/20/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022]
Abstract
AIMS Benzodiazepines and related drugs (BZDR) are often used longer than generally recommended. The aim is to study patterns of use among migrant and Finnish-born users of BZDR, and to identify factors that are associated with long-term use and BZDR polytherapy. METHODS This register-based study includes a nationwide sample of migrants (n=8729) and their Finnish-born controls (n=11 388) who had purchased BZDR in 2011-2014, but not in 2009-2010. Information on drug purchases was obtained from the National Prescription Register and the duration of drug use was estimated using PRE2DUP method. The main outcomes were long-term use of BZDR, polytherapy and time until discontinuation of BZDR use. Sociodemographic variables and information on preceding psychiatric diagnoses were included as covariates. Logistic and Cox regression analyses were the statistical methods used. RESULTS Only migrants from Sub-Saharan Africa were more likely to discontinue the medication once initiated than Finnish-born users. Migrants were significantly less likely to be long-term users (adjusted odds ratio 0.79, 95% CI 0.70-0.89) or polytherapy users (aOR 0.90, 95% CI 0.84-0.97) of BZDR compared with Finnish-born participants. CONCLUSIONS Migrants had less long-term and concomitant use of several BZDR than Finnish-born participants. The pattern of use is more optimal among migrants, but it may also reflect poorer access to mental health treatment.
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Affiliation(s)
- Venla Lehti
- Finnish Institute for Health and Welfare, Equality Unit, Finland
- University of Helsinki and Helsinki University Hospital; Department of Psychiatry, Finland
| | - Essi Salama
- Doctoral Programme for Clinical Investigation, Faculty of Medicine, University of Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Finland
| | - Solja Niemelä
- Department of Psychiatry, University of Turku, Finland
- Department of Psychiatry, Addiction Psychiatry Unit, Turku University Hospital, Finland
| | - Antti Tanskanen
- University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
- Finnish Institute for Health and Welfare, Impact Assessment Unit, Finland
| | - Mika Gissler
- Karolinska Institutet, Department of Molecular Medicine and Surgery and Region Stockholm, Academic Primary Health Care Centre, Sweden
- Finnish Institute for Health and Welfare, Department of Knowledge Brokers, Helsinki, Finland
- University of Turku, Research Centre for Child Psychiatry, Finland
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare, Equality Unit, Finland
| | - Heidi Taipale
- Finnish Institute for Health and Welfare, Equality Unit, Finland
- University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
- University of Eastern Finland, School of Pharmacy, Kuopio, Finland
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2
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Ceuterick M, Van Ngoc P, Bracke P, Scholtes B. From prescribing dilemma to knowledge in practice: The ontological politics of benzodiazepines and Z-drugs. Soc Sci Med 2023; 339:116358. [PMID: 37951056 DOI: 10.1016/j.socscimed.2023.116358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/13/2023]
Abstract
The discrepancy between official guidelines and clinical practice is hardly more pronounced than in the case of benzodiazepines and Z-drugs, also known as benzodiazepine receptor agonists (BZRA). Using social-constructionist positioning theory, we unravel how health care professionals deal with the dilemma of prescribing this medication. Our results reveal a prescribing spectrum that is discursively organised around four different storylines used by professionals. The storylines are organised along three axes that are related to a) prescribers' opinions on prescribing and the negotiation of the related risks, b) the power dynamics between provider and patient in the prescribing process and c) the rhetorical use of arguments. The discerned storylines allow us to explore the emotional and moral side of prescribing and demarcate clinical mindlines -internalised tacit guidelines-that professionals adhere to when they prescribe. By relying on Annemarie Mol's conceptualisation of ontological politics, we explain how these storylines enact multiple versions of this class of medication and justify seemingly contradictory prescribing practices.
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Affiliation(s)
- Melissa Ceuterick
- Hedera, Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Ghent, Belgium.
| | - Pauline Van Ngoc
- Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Piet Bracke
- Hedera, Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Ghent, Belgium
| | - Beatrice Scholtes
- Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, Liège, Belgium
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3
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Engin E. GABA A receptor subtypes and benzodiazepine use, misuse, and abuse. Front Psychiatry 2022; 13:1060949. [PMID: 36713896 PMCID: PMC9879605 DOI: 10.3389/fpsyt.2022.1060949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023] Open
Abstract
Benzodiazepines have been in use for over half a century. While they remain highly prescribed, their unfavorable side-effect profile and abuse liability motivated a search for alternatives. Most of these efforts focused on the development of benzodiazepine-like drugs that are selective for specific GABAA receptor subtypes. While there is ample evidence that subtype-selective GABAA receptor ligands have great potential for providing symptom relief without typical benzodiazepine side-effects, it is less clear whether subtype-selective targeting strategies can also reduce misuse and abuse potential. This review focuses on the three benzodiazepine properties that are relevant to the DSM-5-TR criteria for Sedative, Hypnotic, or Anxiolytic Use Disorder, namely, reinforcing properties of benzodiazepines, maladaptive behaviors related to benzodiazepine use, and benzodiazepine tolerance and dependence. We review existing evidence regarding the involvement of different GABAA receptor subtypes in each of these areas. The reviewed studies suggest that α1-containing GABAA receptors play an integral role in benzodiazepine-induced plasticity in reward-related brain areas and might be involved in the development of tolerance and dependence to benzodiazepines. However, a systematic comparison of the contributions of all benzodiazepine-sensitive GABAA receptors to these processes, a mechanistic understanding of how the positive modulation of each receptor subtype might contribute to the brain mechanisms underlying each of these processes, and a definitive answer to the question of whether specific chronic modulation of any given subtype would result in some or all of the benzodiazepine effects are currently lacking from the literature. Moreover, how non-selective benzodiazepines might lead to the maladaptive behaviors listed in DSM and how different GABAA receptor subtypes might be involved in the development of these behaviors remains unexplored. Considering the increasing burden of benzodiazepine abuse, the common practice of benzodiazepine misuse that leads to severe dependence, and the current efforts to generate side-effect free benzodiazepine alternatives, there is an urgent need for systematic, mechanistic research that provides a better understanding of the brain mechanisms of benzodiazepine misuse and abuse, including the involvement of specific GABAA receptor subtypes in these processes, to establish an informed foundation for preclinical and clinical efforts.
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Affiliation(s)
- Elif Engin
- Stress Neurobiology Laboratory, Division of Basic Neuroscience, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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4
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Zandonai T, Peiró AM, Fusina F, Lugoboni F, Zamboni L. Benzodiazepines in sport, an underestimated problem: Recommendations for sports medicine physicians' practice. Front Psychiatry 2022; 13:1066330. [PMID: 36620691 PMCID: PMC9810623 DOI: 10.3389/fpsyt.2022.1066330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
In the last years, only few studies in literature have focused on the use and abuse of benzodiazepines (BZDs) in sport. Benzodiazepine-related problems include misuse, addiction, driving impairments, and morbidity and mortality related to overdose and withdrawal. Two clinical cases regarding elite endurance athletes evidenced that they had started to use BZDs to counteract insomnia, to recover faster from training sessions and to manage muscle pain. One of the important points that emerged from their stories was that their sports doctors did not recognize the drugs' addictive properties, and did not intervene to gradually reduce the dosage. Experts have previously provided recommendations for BZD therapy management in clinical practice. In this article, we would like to address sports medicine physicians specifically and provide guidelines to help them manage situations involving BZD prescription, the recognition of addiction, and intervention strategies.
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Affiliation(s)
- Thomas Zandonai
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Alicante, Spain.,Neuropharmacology on Pain and Functional Diversity, Institute of Health and Biomedical Research of Alicante (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, Spain.,Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Ana María Peiró
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Alicante, Spain.,Neuropharmacology on Pain and Functional Diversity, Institute of Health and Biomedical Research of Alicante (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, Spain.,Pain Unit, Department of Health of Alicante, University General Hospital, Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante, University General Hospital, Alicante, Spain
| | - Francesca Fusina
- Padova Neuroscience Center, University of Padova, Padua, Italy.,Department of General Psychology, University of Padova, Padua, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
| | - Lorenzo Zamboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
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5
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Zamboni L, Portoghese I, Congiu A, Zandonai T, Casari R, Fusina F, Bertoldi A, Lugoboni F. Polysubstance Use Patterns Among High Dose Benzodiazepine Users: A Latent Class Analysis and Differences Between Male and Female Use. Front Psychiatry 2022; 13:811130. [PMID: 35145442 PMCID: PMC8821140 DOI: 10.3389/fpsyt.2022.811130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/03/2022] [Indexed: 11/23/2022] Open
Abstract
Benzodiazepines (BZDs) represent one of the most widely used groups of pharmaceuticals, but if used for long periods of time they are associated with dependence and an increased risk of harmful effects. High-dose (HD) BZD dependence is a specific substance use disorder associated with a poor quality of life. It is especially important to pinpoint differences in HD BZD addict subgroups in order to tailor treatment to the individual's specific needs, also considering possible comorbidities with other substance use disorders. We conducted a study to evaluate HD BZD dependence (converted doses to diazepam equivalents, mg) in an Italian sample of 1,354 participants. We also investigated if and to which extent participants co-used other substances (alcohol, tobacco, cannabis/cannabinoids, cocaine, and heroin). We then performed latent class analysis (LCA) to identify the use patterns of these substances, finding three classes: participants in Class 1 (4.3% of the sample) had the highest probability of also using cocaine and alcohol (Polysubstance BZD users); Class 2 comprised subjects with the highest probability of being former heroin, cocaine, THC, and alcohol users (Former polysubstance BZD users); Class 3 represented mono-dependence BZD users (78.5% of the sample) and was the most prevalent among women, while young men were most prevalent in Class 1. The present study underlines different characteristics in HD BZD users both concerning other addictions and sex, and also highlights the need for a stricter control of BZD use, ranging from prescriptions to sales.
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Affiliation(s)
- Lorenzo Zamboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy.,Department of Neurosciences, University of Verona, Verona, Italy
| | - Igor Portoghese
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Alessio Congiu
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
| | - Thomas Zandonai
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University, Elche, Spain.,Neuropharmacology on Pain and Functional Diversity (NED), Institute of Health and Biomedical Research of Alicante (ISABIAL), Alicante, Spain
| | - Rebecca Casari
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
| | - Francesca Fusina
- Padova Neuroscience Center, University of Padova, Padova, Italy.,Department of General Psychology, University of Padova, Padova, Italy
| | - Anna Bertoldi
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
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6
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Cloos JM, Lim Cow CYS, Bocquet V. Benzodiazepine high-doses: The need for an accurate definition. Int J Methods Psychiatr Res 2021; 30:e1888. [PMID: 34331787 PMCID: PMC8633930 DOI: 10.1002/mpr.1888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES A clear definition of what we understand of high-dose misuse or of a 'markedly increased dose' (as stated by the DSM-5) is important and past definitions may be inadequate. The aim of this review is to describe the different definitions used and to test these definitions for their accuracy. METHODS A narrative PubMed literature review was conducted based on articles published between 1 January 1990 and 31 December 2020 describing benzodiazepines (in MeSH Terms or MeSH Major Topic) and high-dose (or high-dosage). Specific definitions were applied to a population sample to show how definitions affect high-dose benzodiazepine prevalence. RESULTS Multiples of an equivalent-diazepam dose or of the World Health Organization 'defined daily dosage' were used more frequently than the overstep of the recommended maximum therapeutic dosage as a cut-off point. CONCLUSION High-dose use is rare but the prevalence in the general population varies among studies, mainly due to different definitions, making both clinical and epidemiological comparisons between studies difficult. Defining a high-dose user as a person who takes at least a higher dose than the maximum usual therapeutic dose over a defined period of time therefore appears to be clinically more consistent.
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Affiliation(s)
- Jean-Marc Cloos
- Department of Psychiatry, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | | | - Valéry Bocquet
- Department of Public Health, Competence Centre in Methodology and Statistics, Luxembourg Institute of Health, Luxembourg.,Unité de Soutien Méthodologique, CHU La Réunion, Saint-Denis, France
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7
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Xu KY, Borodovsky JT, Presnall N, Mintz CM, Hartz SM, Bierut LJ, Grucza RA. Association Between Benzodiazepine or Z-Drug Prescriptions and Drug-Related Poisonings Among Patients Receiving Buprenorphine Maintenance: A Case-Crossover Analysis. Am J Psychiatry 2021; 178:651-659. [PMID: 33653119 PMCID: PMC8286284 DOI: 10.1176/appi.ajp.2020.20081174] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Persons with opioid use disorder who take benzodiazepines are at high risk for overdose. The objective of this study was to evaluate the association of benzodiazepine and Z-drug use with drug-related poisonings among patients receiving buprenorphine maintenance treatment. METHODS A case-crossover study design was used to analyze prescription claims among persons ages 12-64 with opioid use disorder who had buprenorphine prescriptions and had claims data in the IBM MarketScan databases (2006-2016), encompassing 14,213,075 person-days of observation time for 23,036 individuals who experienced drug-related poisoning. The exposures were buprenorphine prescriptions and benzodiazepine or Z-drug prescriptions, standardized as daily diazepam-equivalent milligram doses and separated by pharmacologic properties (short-acting or long-acting benzodiazepines, Z-drugs). The outcome of interest was nonfatal drug-related poisoning. Conditional logistic regression was used to evaluate variation in benzodiazepine or Z-drug and buprenorphine use between poisoning and nonpoisoning days. RESULTS Buprenorphine treatment days were associated with a nearly 40% reduction in the risk of poisoning events (odds ratio=0.63, 95% CI=0.60, 0.66) compared with nontreatment days, whereas benzodiazepine or Z-drug treatment days were associated with an 88% increase in the risk of such events (95% CI=1.78, 1.98). In stratified analyses by dose, we observed a 78% (95% CI=1.67, 1.88) and 122% (95% CI=2.03, 2.43) increase in poisonings associated with low-dose and high-dose benzodiazepine or Z-drug treatment days, respectively. High-dose, but not low-dose, benzodiazepine or Z-drug treatment was associated with increased poisonings in combination with buprenorphine cotreatment (odds ratio=1.64, 95% CI=1.39, 1.93), but this was lower than the odds risk associated with benzodiazepine or Z-drug treatment in the absence of buprenorphine (low-dose: odds ratio=1.69, 95% CI=1.60, 1.79; high-dose: odds ratio=2.23, 95% CI=2.04, 2.45). CONCLUSIONS Increased risk of nonfatal drug-related poisoning is associated with benzodiazepine or Z-drug treatment in patients with opioid use disorder, but this risk is partially mitigated by buprenorphine treatment. Dose reduction of benzodiazepines or Z-drugs while maintaining buprenorphine treatment may provide the advantage of lowering drug-related poisoning risk.
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Affiliation(s)
- Kevin Y Xu
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Jacob T Borodovsky
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Ned Presnall
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Carrie M Mintz
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Sarah M Hartz
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Laura J Bierut
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Alvin J Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
| | - Richard A Grucza
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Departments of Family and Community Medicine and Health and Outcomes Research, St. Louis University, St. Louis, MO
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8
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Federico A, Mantovani E, Casari R, Bertoldi A, Lugoboni F, Tamburin S. Adult attention-deficit/hyperactivity disorder symptoms, cognitive dysfunction and quality of life in high-dose use of benzodiazepine and Z-drug. J Neural Transm (Vienna) 2020; 128:1109-1119. [PMID: 33331955 PMCID: PMC8295124 DOI: 10.1007/s00702-020-02285-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/30/2020] [Indexed: 12/11/2022]
Abstract
High-dose use of benzodiazepines (BZDs) and Z-drugs was found to be associated with adult attention deficit/hyperactivity disorder (ADHD) and multidomain cognitive deficits, but the interplay between these factors and its effect on quality of life (QoL) is unclear. We explored (a) whether cognitive dysfunction differs in high-dose BZD/Z-drug users with and without adult ADHD and (b) the impact of cognitive deficits and adult ADHD on QoL in this substance-use disorder (SUD). From January 2015 to December 2019, we recruited 207 high-dose BZD/Z-drug users seeking treatment. We assessed the presence of adult ADHD with a screening tool, which was validated in SUD patients, and collected demographic, clinical and QoL data from the 76 included patients. A neuropsychological battery explored five cognitive domains. We found that: (a) screening for adult ADHD was frequently positive; (b) Short Form-36 (SF-36), a self-administered QoL questionnaire, was worse than the general population and worse in patients positive (ADHD+) vs. those negative (ADHD−) to ADHD screening tool; (c) executive function was significantly worse in ADHD+ than ADHD− patients; (d) some SF-36 dimensions were negatively influenced by executive dysfunction; (e) multivariate analysis showed an interplay between adult ADHD and cognitive dysfunction in worsening QoL. We documented a complex interplay between adult ADHD, cognitive dysfunction and QoL in high-dose BZD/Z-drug users. Assessing adult ADHD, neuropsychological measures and QoL may offer a full scenario of these patients, who are frequently impaired in everyday activities. Future research should explore whether pharmacological treatment might improve cognitive dysfunction and QoL in this SUD.
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Affiliation(s)
- Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy
| | - Rebecca Casari
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, Verona, Italy
| | - Anna Bertoldi
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, Verona, Italy
| | - Fabio Lugoboni
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy.
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9
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Federico A, Lugoboni F, Mantovani E, Martini A, Morbioli L, Casari R, Faccini M, Tamburin S. Detoxification Improves Multidomain Cognitive Dysfunction in High-Dose Benzodiazepine Abusers. Front Neurosci 2020; 14:747. [PMID: 32848544 PMCID: PMC7396668 DOI: 10.3389/fnins.2020.00747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/25/2020] [Indexed: 02/03/2023] Open
Abstract
Purpose High-dose benzodiazepines (BZDs) abuse has been documented to cause multidomain cognitive dysfunction. We explored whether cognitive abnormalities to high-dose BZD abuse might be reversed by detoxification with slow subcutaneous infusion of flumazenil. Methods We recruited 96 patients consecutively admitted to the Department of Internal Medicine, Addiction Medicine Unit, Verona University Hospital, Italy for detoxification from high-dose BZD dependence. After selection for inclusion and exclusion criteria, 50 patients (23 men, 27 women; age 42.7 ± 10.3 years) were included. They underwent a comprehensive neuropsychological battery to explore verbal memory, visuospatial memory, working memory, attention, and executive functions 28–30 days prior to admission for detoxification (T0) and at the end of detoxification, i.e., 7 days after admission (T1). A group of 50 healthy adults (24 men, 26 women; mean age 44.5 ± 12.8 years) matched for age, sex, and education served as controls. Results At T0, patients scored significantly worse than healthy controls in all the neuropsychological tests. Depression and anxiety scores were associated with impaired verbal memory at T0 in patients. T1–T0 comparison showed improved performances in all neuropsychological tests after the end of detoxification in patients. Conclusion We confirmed that all neuropsychological domains were significantly and profoundly impaired by high-dose BZD abuse and documented that cognitive abnormalities improved after detoxification with slow subcutaneous infusion of flumazenil.
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Affiliation(s)
- Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Fabio Lugoboni
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alice Martini
- School of Psychology, Keele University, Newcastle-under-Lyme, United Kingdom
| | - Laura Morbioli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Rebecca Casari
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Marco Faccini
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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10
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Lugoboni F, Bertoldi A, Casari R, Mantovani E, Morbioli L, Tamburin S. Adult Attention-Deficit/Hyperactivity Disorder and Quality of Life in High-Dose Benzodiazepine and Related Z-Drug Users. Eur Addict Res 2020; 26:274-282. [PMID: 32570244 DOI: 10.1159/000507852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Problematic high-dose benzodiazepine (BZD) and related Z-drug use for a long period is a substance use disorder previously found to be associated with adult attention-deficit/hyperactivity disorder (ADHD) and worse quality of life (QoL). Whether adult ADHD impacts QoL in high-dose BZD/Z-drug users has not been explored. AIM The aim of the study was to explore the impact of adult ADHD on QoL in high-dose BZD and related Z-drug users. METHODS We recruited 393 patients (205 men and 188 women) consecutively admitted to the Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Italy, from July 2016 to July 2019 for detoxification from high-dose BZD or Z-drug dependence. Demographic and clinical variables and QoL measures were recorded. The World Health Organization ADHD Self-Report Scale version 1.1 Symptom Checklist Part A was used to detect adult ADHD. RESULTS In our sample, 39.4% of patients were positive to adult ADHD testing (ADHD+), with some clinical features differing in comparison to patients negative to ADHD testing (ADHD-). QoL was worse in high-dose BZD/Z-drug users than the general population. The ADHD+ group showed significantly worse QoL measures than the ADHD- group. Multivariate analysis, including potential covariates showed adult ADHD and age to have the most robust and consistent positive effect for age (i.e., higher QoL) and negative effect for ADHD (i.e., lower QoL) on QoL measures. CONCLUSIONS Adult ADHD is associated with worse QoL measures in high-dose BZD/Z-drug users. Future studies should explore whether appropriate BZD/Z-drug detoxification might improve QoL measures and whether the most appropriate detoxification protocol differs in ADHD+ versus ADHD- populations.
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Affiliation(s)
- Fabio Lugoboni
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Anna Bertoldi
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Rebecca Casari
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Laura Morbioli
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy,
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Filardi AFR, Mendonça SDAM, Ramalho-de-Oliveira D. The use of psychotropic medications and non-pharmacological approaches in everyday life: a qualitative study of the lived experience. REVISTA LATINOAMERICANA DE PSICOPATOLOGIA FUNDAMENTAL 2019. [DOI: 10.1590/1415-4714.2019v22n4p859.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Increased consumption of psychotropic drugs has been noted in Brazil and other Western countries in the last few decades for different reasons. The objective of this study was to understand the lived experience of individuals who used psychotropic drugs to cope with the problems faced in daily life. A qualitative study guided by hermeneutic phenomenology was carried out. In-depth interviews were conducted. The experience was grouped into two themes: experience of using psychotropic and the search for non-pharmacological approaches. Psychotropics were considered necessary for regaining a point of equilibrium when the problems faced were recognized as having a high degree of difficulty. In some cases, the drugs were perceived as insufficient for solving the problem, leading or not to the search for alternatives to deal with the difficulty.
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Faccini M, Tamburin S, Casari R, Morbioli L, Lugoboni F. High-dose lormetazepam dependence: strange case of Dr. Jekyll and Mr. Hyde. Intern Emerg Med 2019; 14:1271-1278. [PMID: 31076977 DOI: 10.1007/s11739-019-02101-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 05/02/2019] [Indexed: 12/30/2022]
Abstract
High-dose benzodiazepine (BZD) abuse is emerging as a substance use disorder (SUD). The aim of the study is to explore the impact of high-dose lormetazepam (LMZ) abuse and the characteristics of patients affected by this SUD in a tertiary referral addiction unit. We have retrospectively evaluated 1112 patients admitted to the Addiction Medicine Unit, Verona University Hospital, Italy for detoxification from high-dose BZD dependence. LMZ was the most common BZD, with an increasing prevalence from January 2003 to June 2018. Socio-demographic (more women; higher age and education) and clinical features (higher daily diazepam dosage equivalent, BZD abuse duration, age of first BZD intake; BZD prescribed more frequently for sleep disorders; less frequent history of other SUDs, previous/active alcohol, previous opioids abuse; more frequent overall major psychiatric diseases and major depression; less-frequent bipolar disorders and other psychoses, personality disorders, and more than one psychiatric disease) of LMZ vs. other BZD abusers significantly differed. 96.7% LMZ abusers took oral solution, while two-thirds of other BZD abusers took tablets. Oral solution, BZD abuse duration and prescription of BZD for sleep disorders increased, while history of other SUDs, previous/active alcohol and active cannabinoids SUD reduced the risk of high-dose LMZ vs. other BZDs abuse. The large prevalence of high-dose LMZ abusers in Italy may be strongly related to the availability and characteristics of oral formulation that may transform the innocuous Dr. Jekyll tablets into an evil Mr. Hyde. Restriction to the market of LMZ oral formulation might reduce the risk of high-dose abuse.
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Affiliation(s)
- Marco Faccini
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, 37134, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy.
| | - Rebecca Casari
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, 37134, Verona, Italy
| | - Laura Morbioli
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, 37134, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy
| | - Fabio Lugoboni
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, 37134, Verona, Italy
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Votaw VR, Geyer R, Rieselbach MM, McHugh RK. The epidemiology of benzodiazepine misuse: A systematic review. Drug Alcohol Depend 2019; 200:95-114. [PMID: 31121495 PMCID: PMC6639084 DOI: 10.1016/j.drugalcdep.2019.02.033] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research. METHODS PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse. RESULTS The search identified 1970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly misused illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment. CONCLUSIONS Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.
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Affiliation(s)
- Victoria R. Votaw
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, USA,Corresponding author: Victoria R. Votaw, Clinical Psychology Ph.D. Student Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, Albuquerque, NM 87131,
| | - Rachel Geyer
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - Maya M. Rieselbach
- Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, USA
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Batlle E, Lizano E, Viñas M, Dolors Pujol M. 1,4-Benzodiazepines and New Derivatives: Description, Analysis, and Organic Synthesis. Med Chem 2019. [DOI: 10.5772/intechopen.79879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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Mendelevich VD. Addictophobia in modern psychiatry (benzodiazepines and other psychopharmacological drugs). Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:75-81. [DOI: 10.17116/jnevro20191191275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Nonmedical prescription sedative/tranquilizer use in alcohol and opioid use disorders. Addict Behav 2019; 88:48-55. [PMID: 30142484 DOI: 10.1016/j.addbeh.2018.08.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/13/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022]
Abstract
AIMS Nonmedical prescription sedative/tranquilizer (e.g., benzodiazepines) use (NMSTU) increases risk of overdose when combined with opioids and/or alcohol. Yet, little is known about NMSTU among those with alcohol and opioid use disorders. We aimed to characterize NMSTU and sedative/tranquilizer use disorder among adults with alcohol use disorder (AUD) and/or opioid use disorder (OUD) in a general population sample. METHODS We conducted analyses of 2008-2014 National Survey on Drug Use and Health data; adults with past-year AUD-only (n = 27,416), OUD-only (n = 2142), and co-occurring AUD and OUD (n = 1483) were included (total N = 31,041). Multivariable logistic regression models were utilized to examine correlates of past-month NMSTU and past-year sedative/tranquilizer use disorder. Focal independent variables were polysubstance use (i.e., number of substances used in the previous year) and psychiatric distress. RESULTS Among those with AUD-only, 27.1% reported lifetime NMSTU, 7.6% reported past-year NMSTU, 2.7% reported past-month NMSTU, and 0.6% met criteria for past-year sedative/tranquilizer use disorder. Corresponding prevalence rates among those with OUD-only were 69.5%, 43.0%, 22.6%, and 11.3%. Those with co-occurring AUD and OUD displayed the highest rates of NMSTU (e.g., 27.5% with past-month NMSTU) and sedative/tranquilizer use disorder (20.2%). Across groups, more severe polysubstance use and psychiatric distress were associated with increased risk of NMSTU and sedative/tranquilizer use disorder. CONCLUSIONS Results of this analysis indicate that >25% of adults with AUD and approximately 70% of those with OUD report lifetime NMSTU. Among these populations, individuals with more polysubstance use and greater psychiatric distress might benefit from targeted interventions to reduce NMSTU.
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17
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Welsh JW, Tretyak V, McHugh RK, Weiss RD, Bogunovic O. Review: Adjunctive pharmacologic approaches for benzodiazepine tapers. Drug Alcohol Depend 2018; 189:96-107. [PMID: 29906718 DOI: 10.1016/j.drugalcdep.2018.04.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Many patients require discontinuation of benzodiazepines due to a reduction in drug efficacy over time, the development of a sedative use disorder, or unwanted side effects. Benzodiazepine discontinuation can pose a significant challenge for prescribing clinicians due to potential withdrawal symptoms and a recurrence of psychiatric complaints. METHODS A PubMed literature search was conducted using the medical subject heading of benzodiazepines in combination with the following key words: discontinuation, withdrawal, detoxification, cessation, dependence, addiction, substance use disorders, or long term. Twenty-one studies met the search criteria. RESULTS Few medications facilitated the successful discontinuation of benzodiazepines or relief from benzodiazepine withdrawal symptoms. CONCLUSIONS Studies were heterogeneous with respect to sample selection, sample size, and outcome measures. Medications targeting insomnia yielded mixed results. Similarly, studies of agents targeting anxiety symptoms demonstrated inconsistent findings in the reduction of anxiety, improvement in withdrawal symptoms, or enhancement of benzodiazepine completion rates. Anticonvulsants have supporting evidence from small case reports; carbamazepine shows some potential in assisting taper completion and reducing withdrawal severity. These conclusions should be considered in light of a number of inconsistencies across studies in the literature. The results of this review article highlight the need for additional research on optimal strategies for facilitating successful benzodiazepine tapers.
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Affiliation(s)
- Justine W Welsh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr. NE, Suite 200, Atlanta, GA 30329, USA.
| | - Valeria Tretyak
- Department of Psychology, University of Texas at Austin, 108 E Dean Keeton St, Austin, TX 78712, USA
| | - R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Harvard Medical School, 115 Mill St, Belmont, MA 02478, USA
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, Harvard Medical School, 115 Mill St, Belmont, MA 02478, USA
| | - Olivera Bogunovic
- Division of Alcohol and Drug Abuse, McLean Hospital, Harvard Medical School, 115 Mill St, Belmont, MA 02478, USA
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18
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McHugh RK, Geyer R, Karakula S, Griffin ML, Weiss RD. Nonmedical benzodiazepine use in adults with alcohol use disorder: The role of anxiety sensitivity and polysubstance use. Am J Addict 2018; 27:485-490. [PMID: 30028048 DOI: 10.1111/ajad.12765] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/25/2018] [Accepted: 07/08/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The nonmedical use of benzodiazepines-defined as use without a prescription or at a dose or frequency higher than prescribed-is increasing among adults in substance use disorder treatment and is associated with risk for overdose. The aim of the current study was to characterize the prevalence of nonmedical benzodiazepine use among adults seeking treatment for alcohol use disorder and to examine whether nonmedical benzodiazepine use was associated with: (1) polysubstance use and (2) greater anxiety sensitivity. METHODS A sample of 461 treatment-seeking adults with alcohol use disorder who were recruited for a cross-sectional study were included in this analysis. RESULTS A total of 89 participants (19%) reported nonmedical benzodiazepine use in the previous 30 days. Results of a logistic regression indicated that polysubstance use (number of substances used in the past month) was associated with nonmedical benzodiazepine use. The association between anxiety sensitivity and nonmedical benzodiazepine misuse was moderated by gender; anxiety sensitivity was associated with benzodiazepine use among women, but not men. DISCUSSION AND CONCLUSIONS These results replicate findings from research on opioid use disorder suggesting that anxiety sensitivity is associated with nonmedical benzodiazepine use in women and not men. SCIENTIFIC SIGNIFICANCE Targeted intervention to those with polysubstance use-including education on overdose risk when benzodiazepines are combined with other substances-is indicated in men and women with alcohol use disorder. Anxiety sensitivity may be a potential therapeutic target to reduce nonmedical benzodiazepine use among women with alcohol use disorder. (Am J Addict 2018;27:485-490).
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Rachel Geyer
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
| | - Sterling Karakula
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
| | - Margaret L Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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19
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Serre A, Eiden C, Gourhant V, Laureau M, Perier D, Giraud I, Sebbane M, Peyrière H. [Involvement of addictovigilance in emergency department for the detection of abuse and dependence cases: 3 years of experience]. Therapie 2018; 73:501-509. [PMID: 30017376 DOI: 10.1016/j.therap.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Due to the increase of hospitalization at emergency department (ED) related to psychoactive substances use (PSU), the addictovigilance center of Montpellier has been integrated into the URGEIM program for the detection of iatrogenic events at the ED. The objective of the present work was to analyze spontaneous reports (SR) collected via the URGEIM program. METHODS Analysis of spontaneous reports related to PSU at the ED of the Montpellier University Hospital, collected through the URGEIM program, between January 2014 and December 2016. RESULTS During the study period, 160 SR were collected through the URGEIM program on 1118 SR collected by the Addictovigilance center over the period: 40SR/342 in 2014, 46 SR/303 in 2015 and 74 SR/473 in 2016. Most patients were male (70%) and the mean age at admission was 33 years old. A total of 240 psychoactive substances were identified with 160 illicit substances (66.6%) [cocaine 38.1%, cannabis 30.6%] and 80 medications (33.3%) [buprenorphine 22.5%, benzodiazepines 20% and methadone 18.8%]. Mental and behavioral disorders (20.0%), general health problems associated with substance use (17.5%), cardiovascular diseases (13.1%) and infectious diseases (12.5%) were the main reported effects. The duration of emergency stay was inferior to 12hours in 63.1% of cases and greater than 24hours in 12.5% of cases. In 69.4% of cases, the event was considered as serious. The outcome was unknown for 6.9% of patients. CONCLUSION The number of SR from ED has increased over the study period, with the notification of serious and worrying cases, and the possibility of setting up actions. The deployment of addictovigilance within clinical services is a significant factor for notification and quality of care.
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Affiliation(s)
- Anaïs Serre
- Département de pharmacologie médicale et toxicologie, centre d'addictovigilance, hôpital Lapeyronie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Céline Eiden
- Département de pharmacologie médicale et toxicologie, centre d'addictovigilance, hôpital Lapeyronie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Vincent Gourhant
- Département des urgences, centre hospitalier universitaire, 34295 Montpellier, France
| | - Marion Laureau
- Département de pharmacie clinique et dispensation, pharmacie, centre hospitalier universitaire, 34295 Montpellier, France
| | - Damien Perier
- Département des urgences, centre hospitalier universitaire, 34295 Montpellier, France
| | - Isabelle Giraud
- Département des urgences, centre hospitalier universitaire, 34295 Montpellier, France
| | - Mustapha Sebbane
- Département des urgences, centre hospitalier universitaire, 34295 Montpellier, France
| | - Hélène Peyrière
- Département de pharmacologie médicale et toxicologie, centre d'addictovigilance, hôpital Lapeyronie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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Tamburin S, Faccini M, Casari R, Federico A, Morbioli L, Franchini E, Bongiovanni LG, Lugoboni F. Low risk of seizures with slow flumazenil infusion and routine anticonvulsant prophylaxis for high-dose benzodiazepine dependence. J Psychopharmacol 2017; 31:1369-1373. [PMID: 28613124 DOI: 10.1177/0269881117714050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
High-dose benzodiazepine (BZD) dependence represents an emerging and under-reported addiction phenomenon and is associated with reduced quality of life. To date there are no guidelines for the treatment of high-dose BZD withdrawal. Low-dose slow flumazenil infusion was reported to be effective for high-dose BZD detoxification, but there is concern about the risk of convulsions during this treatment. We evaluated the occurrence of seizures in 450 consecutive high-dose BZD dependence patients admitted to our unit from April 2012 to April 2016 for detoxification with low-dose slow subcutaneous infusion of flumazenil associated with routine anticonvulsant prophylaxis. In our sample, 22 patients (4.9%) reported history of convulsions when previously attempting BZD withdrawal. Only four patients (0.9%) had seizures during ( n = 2) or immediately after ( n = 2) flumazenil infusion. The two patients with seizures during flumazenil infusion were poly-drug misusers. The most common antiepileptic drugs (AEDs) used for anticonvulsant prophylaxis were either valproate 1000 mg or levetiracetam 1000 mg. Our data indicate that, when routinely associated with AEDs prophylaxis, low-dose slow subcutaneous flumazenil infusion represents a safe procedure, with low risk of seizure occurrence.
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Affiliation(s)
- Stefano Tamburin
- 1 Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Faccini
- 2 Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Rebecca Casari
- 2 Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Angela Federico
- 1 Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Laura Morbioli
- 2 Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Enrica Franchini
- 1 Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Fabio Lugoboni
- 1 Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Tamburin S, Federico A, Morbioli L, Faccini M, Casari R, Zamboni L, Briguglio G, Lugoboni F. Screening for adult attention deficit/hyperactivity disorder in high-dose benzodiazepine dependent patients. Am J Addict 2017; 26:610-614. [DOI: 10.1111/ajad.12573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/09/2017] [Accepted: 05/13/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine, and Movement Sciences; University of Verona; Verona Italy
| | - Angela Federico
- Department of Neurosciences, Biomedicine, and Movement Sciences; University of Verona; Verona Italy
| | - Laura Morbioli
- Department of Medicine, Addiction Medicine Unit; Verona University Hospital; Verona Italy
| | - Marco Faccini
- Department of Medicine, Addiction Medicine Unit; Verona University Hospital; Verona Italy
| | - Rebecca Casari
- Department of Medicine, Addiction Medicine Unit; Verona University Hospital; Verona Italy
| | - Lorenzo Zamboni
- Department of Medicine, Addiction Medicine Unit; Verona University Hospital; Verona Italy
| | - Giuseppe Briguglio
- Department of Medicine, Addiction Medicine Unit; Verona University Hospital; Verona Italy
| | - Fabio Lugoboni
- Department of Medicine, Addiction Medicine Unit; Verona University Hospital; Verona Italy
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High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:17-27. [PMID: 28577506 DOI: 10.1016/j.drugpo.2017.05.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 04/08/2017] [Accepted: 05/03/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Benzodiazepines are a widely prescribed psychoactive drug; in the U.S., both medical and nonmedical use of benzodiazepines has increased markedly in the past 15 years. Long-term use can lead to tolerance and dependence, and abrupt withdrawal can cause seizures or other life-threatening symptoms. Benzodiazepines are often used nonmedically in conjunction with other drugs, and with opioids in particular-a combination that can increase the risk for fatal and non-fatal overdose. This mixed-methods study examines nonmedical use of benzodiazepines among young adults in New York City and its relationship with opioid use. METHODS For qualitative analysis, 46 90-minute semi-structured interviews were conducted with young adult opioid users (ages 18-32). Interviews were transcribed and coded for key themes. For quantitative analysis, 464 young adult opioid users (ages 18-29) were recruited using Respondent-Driven Sampling and completed structured interviews. Benzodiazepine use was assessed via a self-report questionnaire that included measures related to nonmedical benzodiazepine and opioid use. RESULTS Participants reported using benzodiazepines nonmedically for a wide variety of reasons, including: to increase the high of other drugs; to lessen withdrawal symptoms; and to come down from other drugs. Benzodiazepines were described as readily available and cheap. There was a high prevalence (93%) of nonmedical benzodiazepine use among nonmedical opioid users, with 57% reporting regular nonmedical use. In bivariate analyses, drug-related risk behaviours such as polysubstance use, drug binging, heroin injection and overdose were strongly associated with regular nonmedical benzodiazepine use. In multivariate analysis, growing up in a middle-income household (earning between $51,000 and $100,000 annually), lifetime overdose experience, having ever used cocaine regularly, having ever been prescribed benzodiazepines, recent drug binging, and encouraging fellow drug users to use benzodiazepines to cope with opioid withdrawal were consistently strong predictors of regular nonmedical benzodiazepine use. CONCLUSION Nonmedical benzodiazepine use may be common among nonmedical opioid users due to its drug-related multi-functionality. Harm reduction messages should account for the multiple functions benzodiazepines serve in a drug-using context, and encourage drug users to tailor their endorsement of benzodiazepines to peers to include safer alternatives.
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Tamburin S, Federico A, Faccini M, Casari R, Morbioli L, Sartore V, Mirijello A, Addolorato G, Lugoboni F. Determinants of Quality of Life in High-Dose Benzodiazepine Misusers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14010038. [PMID: 28054975 PMCID: PMC5295289 DOI: 10.3390/ijerph14010038] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/20/2016] [Accepted: 12/29/2016] [Indexed: 02/04/2023]
Abstract
Benzodiazepines (BZDs) are among the most widely prescribed drugs in developed countries, but they have a high potential for tolerance, dependence and misuse. High-dose BZD misuse represents an emerging addiction phenomenon, but data on quality of life (QoL) in high-dose BZD misusers are scant. This study aimed to explore QoL in high-dose BZD misuse. We recruited 267 high-dose BZD misusers, compared the QoL scores in those who took BZD only to poly-drug misusers, and explored the role of demographic and clinical covariates through multivariable analysis. Our data confirmed worse QoL in high-dose BZD misusers and showed that (a) QoL scores were not negatively influenced by the misuse of alcohol or other drugs, or by coexisting psychiatric disorders; (b) demographic variables turned out to be the most significant predictors of QoL scores; (c) BZD intake significantly and negatively influenced QoL. Physical and psychological dimensions of QoL are significantly lower in high-dose BZD misusers with no significant effect of comorbidities. Our data suggest that the main reason for poor QoL in these patients is high-dose BZD intake per se. QoL should be considered among outcome measures in these patients.
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Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, Verona 37134, Italy.
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, Verona 37134, Italy.
| | - Marco Faccini
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy.
| | - Rebecca Casari
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy.
| | - Laura Morbioli
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy.
| | - Valentina Sartore
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy.
| | - Antonio Mirijello
- Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Rome, Rome 00168, Italy.
| | - Giovanni Addolorato
- Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Rome, Rome 00168, Italy.
| | - Fabio Lugoboni
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy.
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Bakker A, Streel E. Benzodiazepine maintenance in opiate substitution treatment: Good or bad? A retrospective primary care case-note review. J Psychopharmacol 2017; 31:62-66. [PMID: 28072037 DOI: 10.1177/0269881116675508] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Co-prescribing benzodiazepines to patients in opiate substitution treatment is controversial and often alleged to increase mortality. In an inner-London general practice, patients with problematic benzodiazepine co-dependence were allowed benzodiazepine maintenance treatment (BMT) since 1994, providing an opportunity for analysis. METHOD 1) Case-note review of all 278 opiate substitution treatment patients, accruing 1289 patient treatment years; 46% had concurrent BMT. 2) National Health Service database search for patients who died after leaving accrued a further 883 years of information; only patients who left the UK were unaccounted for (4%). Three groups were studied: 1) never obtained benzodiazepine prescription (NOB): n=80); 2) briefly/occasionally prescribed benzodiazepines (BOP): n=71; 3) BMT: n=127. OUTCOMES MEASURED Treatment retention (months); deaths/100 patient treatment years; deaths after leaving the service/100 years of information. RESULTS Treatment retention: NOB: 34 months; BOP: 51 months; BMT: 72 months. In-treatment mortality: NOB: 1.79/100 patient treatment years; BOP: 0.33/100 patient treatment years; BMT: 1.31/100 patient treatment years. Deaths after leaving service: NOB: 2.24/100 years of information, BOP: 0.63/100 years of information. However, mortality for previously BMT-patients increased by 450% to 5.90/100 years of information. DISCUSSION BMT patients had longer treatment retention than NOB or BOP and lower mortality than NOB patients. It is unlikely that patients had access to prescribed benzodiazepines on leaving the service because of restrictions in the national guidelines but co-dependent patients are a high-risk group who may stand to gain most benefit from opiate substitution treatment if combined with benzodiazepine-maintenance.
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Federico A, Tamburin S, Maier A, Faccini M, Casari R, Morbioli L, Lugoboni F. Multifocal cognitive dysfunction in high-dose benzodiazepine users: a cross-sectional study. Neurol Sci 2016; 38:137-142. [DOI: 10.1007/s10072-016-2732-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/05/2016] [Indexed: 11/29/2022]
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Liebrenz M, Schneider M, Buadze A, Gehring MT, Dube A, Caflisch C. Attitudes towards a maintenance (-agonist) treatment approach in high-dose benzodiazepine-dependent patients: a qualitative study. Harm Reduct J 2016; 13:1. [PMID: 26743909 PMCID: PMC4705614 DOI: 10.1186/s12954-015-0090-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 12/11/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND High-dose benzodiazepine dependence constitutes a major clinical concern. Although withdrawal treatment is recommended, it is unsuccessful for a significant proportion of affected patients. More recently, a benzodiazepine maintenance approach has been suggested as an alternative for patients' failing discontinuation treatment. While there is some data supporting its effectiveness, patients' perceptions of such an intervention have not been investigated. METHODS An exploratory qualitative study was conducted among a sample of 41 high-dose benzodiazepine (BZD)-dependent patients, with long-term use defined as doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use, such as mixing substances, dose escalation, recreational use, or obtainment by illegal means. A qualitative content analysis approach was used to evaluate findings. RESULTS Participants generally favored a treatment discontinuation approach with abstinence from BZD as its ultimate aim, despite repeated failed attempts at withdrawal. A maintenance treatment approach with continued prescription of a slow-onset, long-acting agonist was viewed ambivalently, with responses ranging from positive and welcoming to rejection. Three overlapping themes of maintenance treatment were identified: "Only if I can try to discontinue…and please don't call it that," "More stability and less criminal activity…and that is why I would try it," and "No cure, no brain and no flash…and thus, just for everybody else!" CONCLUSIONS Some patients experienced slow-onset, long-acting BZDs as having stabilized their symptoms and viewed these BZDs as having helped avoid uncontrolled withdrawal and abstain from criminal activity. We therefore encourage clinicians to consider treatment alternatives if discontinuation strategies fail.
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Affiliation(s)
- Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Legal Medicine, University of Bern, Bern, Switzerland.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
| | - Marcel Schneider
- Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
| | | | - Anish Dube
- University of Pennsylvania Health System, Philadelphia, USA.
| | - Carlo Caflisch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
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