Benzodiazepine Legal Status
The benefits of benzodiazepines are the least significant and the risks are greatest in the elderly. [89] [90] They are listed by the American Geriatrics Society as a potentially inappropriate drug for the elderly. [91] Older adults have an increased risk of addiction and are more susceptible to adverse effects such as memory problems, daily sedation, limited motor coordination, and an increased risk of traffic accidents and falls,[49] as well as an increased risk of hip fractures. [92] The long-term effects of benzodiazepines and benzodiazepine dependence in older adults may resemble dementia, depression or anxiety syndromes and worsen over time. The negative effects on cognition can be confused with the effects of age. The benefits of withdrawal include improved cognition, alertness, mobility, a reduced risk of incontinence, and a reduced risk of falls and fractures. The success of progressive benzodiazepine rejuvenation is as great in the elderly as in the youngest. Benzodiazepines should be prescribed to the elderly only with caution and only for a short time in low doses. [93] [94] Short to moderate benzodiazepines are preferred in the elderly, such as oxazepam and temazepam. The highly effective benzodiazepines alprazolam and triazolam and long-acting benzodiazepines are not recommended in the elderly due to increased side effects. Non-benzodiazepines such as zaleplon and zolpidem and low doses of sedative antidepressants are sometimes used as alternatives to benzodiazepines. [94] [95] Overall, anecdotal evidence suggests that temazepam may be the most psychotropic (addictive) benzodiazepine.
Non-medical use of temazepam has reached epidemic proportions in some parts of the world, particularly in Europe and Australia, and is an important addictive substance in many Southeast Asian countries. This has prompted authorities in various countries to place temazepam under a more restrictive legal status. Some countries, such as Sweden, have banned the drug altogether. [218] Temazepam also has certain pharmacokinetic absorption, distribution, elimination and clearance properties that make it more suitable for non-medical use than many other benzodiazepines. [219] [220] Nonbenzodiazepines also bind to the benzodiazepine binding site at the GABAA receptor and have similar pharmacological properties. Although non-benzodiazepines are by definition not structurally related to benzodiazepines, both classes of drugs have a common pharmacophore (see figure below on the right), which explains their binding to a common receptor site. [184] All of this means that people who use benzodiazepines often take a much stronger and more dangerous drug than they think, or that the tablet`s brands might suggest. Due to their muscle-relaxing effect, benzodiazepines can cause respiratory depression in sensitive people.
For this reason, they are contraindicated in people with myasthenia gravis, sleep apnea, bronchitis and COPD. [80] [81] Caution should be exercised when benzodiazepines are used in people with personality or intellectual disabilities due to common paradoxical reactions. [80] [81] In severe depression, they can trigger suicidal tendencies[82] and are sometimes used for suicidal overdoses. [81] People who have consumed too much alcohol or used opioids or barbiturates for non-medical purposes in the past should avoid benzodiazepines, as there is a risk of life-threatening interactions with these drugs. [83] Benzodiazepines are used in veterinary practice to treat a variety of diseases and conditions. All benzodiazepines are classified as Schedule IV substances under the Controlled Drugs and Substances Act. [200] Since 2000, benzodiazepines have been classified as target substances, which means that there are additional requirements for pharmacists` records, among other things. [201] Since about 2014, Health Canada, the Canadian Medical Association, and the Provincial Colleges of Physicians and Surgeons have published increasingly stringent guidelines for prescribing benzodiazepines, particularly for seniors (e.g., College of Physicians and Surgeons of British Columbia). [202] Many of these guidelines are not readily available to the public. [203] Although the final studies are missing, the first view was supported by a meta-analysis of 13 small studies from 2004.
[107] [109] This meta-analysis found that long-term benzodiazepine use was associated with moderate to significant adverse effects on all areas of cognition, with visual and spatial memory being the most frequently observed impairment. Some of the other deficiencies reported were decreased IQ, video-motor coordination, information processing, verbal learning and concentration. The authors of the meta-analysis[109] and a subsequent reviewer[107] found that the applicability of this meta-analysis is limited because the subjects came primarily from rehabilitation clinics; the coexistence of drugs, alcohol use and psychiatric disorders has not been defined; and several of the included studies performed cognitive measures during the waiting period. Prolonged epileptic seizures are a medical emergency that can usually be effectively treated by administering fast-acting benzodiazepines, which are powerful anticonvulsants. In hospital settings, intravenous clonazepam, lorazepam and diazepam are the first choice. In the Community, intravenous administration is not practicable and rectal diazepam or oral midazolam are therefore used, with a preference for midazolam, as its administration is simpler and more socially acceptable. [51] [52] Benzodiazepines (BZD, BDZ, BZ), sometimes referred to as “benzos” or “blues”, are a class of psychoactive drugs whose nuclear chemical structure is the fusion of a benzene ring and a diazepine ring. As sedatives – drugs that reduce brain activity – they are prescribed to treat conditions such as anxiety, insomnia and seizures. The first benzodiazepine, chlordiazepoxide (Librium), was discovered by chance by Leo Sternbach in 1955 and supplied by Hoffmann-La Roche in 1960, followed by diazepam (Valium) in 1963. [1] Until 1977, benzodiazepines were the most commonly prescribed drugs in the world; The introduction of selective serotonin reuptake inhibitors (SSRIs) has reduced prescribing rates, among other things, but they continue to be widely used worldwide. [2] [3] Proper storage and possession of prescription benzodiazepines is particularly important in states where possession of prescription drugs outside the original container is considered a criminal offence.
In these states, an order must be kept in the original container to be considered lawful possession. These laws contain certain exceptions to common sense, such as the use and necessary repackaging of drugs in other approved medical containers. However, the laws specifically prohibit the storage of prescriptions in unauthorized purses, bags, bags, or other storage devices. The effects of an overdose on benzodiazepines include drowsiness, confusion, impaired coordination, breathing problems (difficulty breathing) and coma. An overdose can be fatal. If you or a loved one notices any of the signs of an overdose, you should immediately see an emergency doctor. People who use a lot of benzodiazepines may have poor withdrawal symptoms, which may include tremors, nausea, vomiting, headaches, anxiety, panic attacks, and depression. People who experience these withdrawal symptoms may have seizures. In September 2020, the U.S.
Food and Drug Administration (FDA) required that the packaged warning be updated for all benzodiazepines to describe the risks of abuse, abuse, addiction, physical dependence, and withdrawal responses consistently across all drugs in the class. [108] In the United States, the Food and Drug Administration has classified benzodiazepines as category D or X, which means that the potential for harm to the unborn child has been demonstrated. [84] Research has shown that benzodiazepines can cause harmful psychological and physical dependence. Some withdrawal symptoms can be fatal. Some medications used to treat anxiety disorders fall under the legal classification of “controlled substances.” Benzodiazepines, a class of drugs commonly used for their sedative and anxiolytic effects, are considered a List IV controlled substance (Ativan and Valium are examples of benzodiazepines. Although some people mistake it for an opioid, the Xanax class of drugs is also benzodiazepine.) But what exactly does it mean to be a Controlled List IV substance? Chlordiazeperoxide is the most commonly used benzodiazepine for alcohol detoxification,[55] but diazepam can be used as an alternative. Both are used in the detoxification of people who are motivated to stop drinking and are prescribed for a short period of time to reduce the risk of developing tolerance and dependence on the benzodiazepine drug itself. [24]: 275 Benzodiazepines with a longer half-life make detoxification more bearable, and dangerous (and potentially fatal) alcohol withdrawal symptoms occur less frequently.
