1. Benzodiazepines

2. Reconnexion What are benzodiazepines?  Minor tranquillisers and sleeping pills Properties:  Relieve anxiety  Sedative  Anti-convulsant  Muscle relaxant

3. Reconnexion List of benzodiazepines Half life (hrs) Generic nameBrand names 10-14AlprazolamXanax, Kalma 22-54ClonazepamRivotril, Paxam 20-48DiazepamValium, Antenax, Ducene 25-30FlunitrazepamRohypnol, Hypnodorm 15-38NitrazepamMogadon, Alodorm 6-10OxazepamSerepax, Murelax, Alepam 5-10TemazepamNormison, Temaze, Euhypnos, Temtabs, Nocturne

4. Reconnexion Indications for valid prescribing of benzodiazepines  Anxiety disorders  Sleep  Muscle Relaxant  Medical procedures  Alcohol withdrawal They are not validly prescribed for: o Grief, anger, depression, drug withdrawal.

5. Reconnexion RACGP Guidelines  Should be prescribed for the shortest possible time, lowest possible dose  Ideally no more than 7 days  Maximum 2-4 weeks  “limited to patients whose symptoms are disabling or who are subjected to unacceptable distress”  Only when other treatments have failed

6. Reconnexion Benzodiazepine Dependency  Estimated 50-80% of people using benzodiazepines continuously to 6-12 months will become dependent.  Those who become dependent will experience withdrawal, although severity will vary.  For long term users, withdrawal symptoms may be present while on the regular dose (“Breakthrough withdrawal”)

7. Reconnexion Benzodiazepine binding sites  Most commonly found in areas of the brain controlling our consciousness, coordination, emotions, memory, muscle tone and thinking.

8. Reconnexion Benzodiazepines are prescribed for;  Most often women  Older people  Migrant population

9. Reconnexion Benzodiazepine withdrawal  Wide range of distressing symptoms  Anxiety and insomnia are common withdrawal symptoms –often the presenting problem  Can be protracted – weeks or months

10. Reconnexion Benzodiazepine Withdrawal  Onset: 2-3 days for short-acting 5-7 days for long-acting  Symptoms typically last 2-4 weeks, up to a few months  Symptoms can be more intense at the beginning and end of reduction  Symptoms typically fluctuate  Symptoms vary from mild to severe

11. Reconnexion Common withdrawal symptoms  Anxiety & panic attacks  Insomnia  Heightened sensitivity of the senses  Muscle twitching and spasm  Pins and needles  Nausea  Dizziness  Depression  Loss of memory  Loss of appetite  Hallucinations

12. Reconnexion Specific Risks for Polydrug Users  Greatly increased risk of overdose  Increased risk taking behaviour – sharing needles, sexual promiscuity, unsafe sex  Disinhibition – more aggressive, socially inappropriate, increased risk of sexual assault  Increased offending (with memory loss)  Specific harms from IV use of benzos

13. Reconnexion Overdose statistics (Victorian Institute of Forensic Medicine 2005)  In all deaths involving heroin 2001-2005, benzodiazepines were found in 60% of cases (Cf 31% alcohol, 20% heroin alone)

14. Reconnexion IV use of benzodiazepines  Many of the benzodiazepines are an irritant, essentially burning the vein lining.  Veins narrow and block, reducing blood flow  May cause severe infection of skin and bone.  Particles in the tablets/capsules do not break down small enough to inject  If the vein is missed, tissue surrounding the injection site may become infected, causing swelling, infection, abscesses or ulcers.  Can cause blood clots in the lungs

15. Reconnexion Older people and medication Older people  37% sleeping tablets  15% antidepressants Adult population  4% sleeping tablets  5% antidepressants

16. Reconnexion Effects of benzodiazepines for older people  Over sedation  Falls and hip fractures  Impaired blood pressure regulation  Cognitive impairment & memory loss  Nocturnal urinary incontinence  Emotional changes- worsening depression  Worsening sleep  Respiratory problems