1. 1 Benzodiazepines and Similar Drugs: Misuse, Abuse, and Dependence Randy Brown, MD University of Wisconsin, Madison Alcohol Medical Scholars Program Copyright Alcohol Medical Scholars Program

2. 2 Key Points Daily use of benzodiazepines (BZs) = risky Certain situations ↑ risk –Prescribing practices/med characteristics –Patient characteristics Taper BZs slowly if daily use ~2+ weeks Copyright Alcohol Medical Scholars Program

3. 3 What Are Benzodiazepines (BZs) ? Sedative-hypnotic Flurazepam (Dalmane) Temazepam (Restoril) Triazolam (Halcion) Anxiolytic Alprazolam (Xanax) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Diazepam (Valium) Copyright Alcohol Medical Scholars Program Related meds = Non-BZ BZ receptor agonists (BZRAs) Zolpidem (Ambien)

4. 4 Adverse Effects Motor impairment (reaction time) Cognitive impairment (sedation, amnesia) Increased risk –Age > 65 –Alcohol –Using >1 BZ –Highly lipid soluble BZ (e.g. diazepam) Copyright Alcohol Medical Scholars Program BZRAs ≤ BZs

5. 5 “Misuse” & Use Disorders Misuse –Long-term –Non-medical Abuse = dysfunction in 1+ areas Dependence = 3+ of 7 criteria repetitively Physical dependence (2 criteria) Compulsive use/loss of control (5 criteria) Copyright Alcohol Medical Scholars Program

6. 6 Misuse: Medication Factors Dose/duration –↑ dose –2+ weeks daily use Short half-life –Triazolam ~6 hrs vs. chlordiazepoxide ~20 hrs Highly lipid soluble BZ (e.g. diazepam) Copyright Alcohol Medical Scholars Program

7. 7 Misuse: Patient Factors Substance dependence history –BZs, alcohol + Psychiatric history –Anxiety, depression + Social & demographic factors –Age, gender, unemployment, poor social support + Copyright Alcohol Medical Scholars Program

8. 8 Tapering BZs 1) 2-4 doses daily 2) Taper 25% every 3 days 3) Slower in last half Provide support behavioral therapy engage close family Copyright Alcohol Medical Scholars Program

9. 9 Summary Long-term use (> 2 weeks) ↑ risk for: –Side effects –Misuse, abuse, & dependence Prescribing practices & patient characteristics ↑ risk If taken for > 2 weeks, taper slowly Copyright Alcohol Medical Scholars Program