There was no difference in the success rate of BZD discontinuation between the control and experimental groups in this case 72. The use and discontinuation of alprazolam within 2 weeks disrupt sleep onset and quality, increasing suicide risks 51. If you suddenly reduce your dose of benzodiazepines or stop taking them – even if you’ve been using them as prescribed by a doctor – you could have withdrawal symptoms. Well-designed human studies addressing alprazolam’s reinforcing effects and the discontinuation syndrome are needed, and must consider important issues such as selection of appropriate comparison drug, dose, formulation, and population. Future research should also further investigate the misuse liability of alprazolam XR, and should attempt to clarify the role of carbamazepine, clonidine, other anticonvulsant drugs, and related compounds in the treatment of the alprazolam withdrawal syndrome.

Data Availability Statement

• Long-term use of benzodiazepine in general is controversial and not recommended, although commonly practiced.
• El Zahran et al (19) reported a slightly lower rate of 47.8% for abuse or inappropriate medication use among the elderly aged 66 and above.
• This result could be a consequence of the generally low representation of this age group (3.21% of the total sample, with only 25 individuals chronically using benzodiazepines).
• In a survey of British general practitioners, many reported pressures in prescribing BZD to patients and a lack of adequate knowledge on alternative psychological treatment for insomnia 41.
• Because just 3 of 44 characteristic x age interactions in bivariate tests were statistically significant,d,e,f characteristic-by-age interactions were not included in the adjusted model.

Related to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS benzodiazepine use, misuse, and abuse: a review pathology, muscle relaxation, and epilepsy. The dependence on BZDs generally leads to withdrawal symptoms, requiring careful tapering of the medication when prescribed. Regular use of BZDs has been shown to cause severe, harmful psychological and physical dependence, leading to withdrawal symptoms similar to that of alcohol withdrawal.

Prevalence

Future research is also warranted to be aware of the changing patterns and to avoid misuse and/or abuse at an epidemic level. Benzodiazepines are effective in managing anxiety and related disorders when used properly (short-term). Their inappropriate use, however, carries significant risks, involving amnesia, rebound insomnia, rebound anxiety, depression, dependence, abuse, addiction, and an intense and exceedingly prolonged withdrawal, among other complications.

Under “benzodiazepine users overall”, a row presents the proportion of benzodiazepine use within that stratum that is as-prescribed or misuse (e.g., among adults 18-25, 51.0% benzodiazepine use reported is misuse). Respondents could report benzodiazepine use through survey queries regarding tranquilizer or sedative use. NSDUH classifies tranquilizers as medications specifically for relief of anxiety or muscle spasms and sedatives as those for insomnia. This analysis is limited to the 10,290 respondents who specifically reported benzodiazepine use in response to the tranquilizer and sedative items (see online Appendix for additional detail). Against the backdrop of the gradual adoption of new guidelines for prescribing benzodiazepines, it is important to emphasize that long-term users are particularly at risk—both of having received insufficient information in the past and of developing addiction due to prolonged use. Although addiction guidelines offer recommendations for tapering 38, this process requires prescribers to first assess and diagnose patients, and secondly, to have the necessary resources to support patients throughout tapering.

Implementation of mMINDS monitoring for alcohol withdrawal at an inpatient academic psychiatric facility

They found that the hazard of death was doubled in patients prescribed BZD compared to control patients 47. There was an association between the prescription of anxiolytic drugs and mortality, resulting in 4 excess deaths in the anxiolytic drug group within an average of 7.6 years 47. They found a 35% increased chance of developing a new non-melanoma cancer in users of hypnotics 48. In agreeing with some of the studies above, there was also a 4.6-fold increase in the hazard of death in patients on hypnotics over 2.5 years 48.

Considering the widespread nature of benzodiazepine use, there is a dearth of research exploring the long-term experiences of these drugs from the user perspective. While several qualitative studies include benzodiazepine users 20, few delve into perceptions related to prolonged use and the impact of significant changes in regulation and prescribing of these medications over time. The perspectives of individuals with a history of long-term use are of interest as previously acceptable prescription patterns are now seen as contributing to addiction risk in updated guidelines.

Limitations and potential for further research

• After exerting their effect, BZDs are metabolized primarily by the liver and excreted by conjugation, so they should be used in caution in the elderly, smokers, and those with liver disease or damage 3.
• To our knowledge, this is the first analysis of benzodiazepine use in the U.S. to find that adults ≥65 no longer have the highest prevalence.
• Despite their popularity, our understanding of how benzodiazepines and opioids interact is less than adequate.
• We included past-year alcohol, marijuana, and heroin use or abuse/dependence; past-year use of tobacco products; and past-year prescription use, misuse, or abuse/dependence of prescription opioids and stimulants.

This study found that patients undergoing this structured intervention were 5-fold more likely to successfully discontinue BZD than those who just tapered off the drug 73. Interestingly, a lower prevalence of withdrawal symptoms was noted in the experimental group without any change in pharmacologic treatment from control group 73. However, this study included a small sample size, so a larger study using this standardized counseling method would increase the validity of the results of this study 73.

When combining all benzodiazepines—free, bought, or stolen—a friend or relative was the source for nearly 70% of respondents reporting misuse. The odds ratio reports the odds of a specific misuse characteristic (i.e., a table row) among adults ≥50y compared to younger adults (18-49y) as the reference group. For example, the odds of misuse without a prescription among older adults relative to younger adults is .36. SAMHSA requires that any description of overall sample sizes based on the restricted-use data files has to be rounded to the nearest 100, which intends to minimize potential disclosure risk. SAMHSA requires that any description of overall sample sizes based on the restricted-use data files be rounded to the nearest 100, which intends to minimize potential disclosure risk.

Associated Data

We examined data from adults aged 18 or older who participated in the 2015–2016 National Surveys on Drug Use and Health (NSDUH), which was conducted by the Substance Abuse and Mental Health Services Administration. Starting in 2015, NSDUH collects information on benzodiazepine use, providing the first opportunity to obtain nationally representative data on benzodiazepine use, misuse, and motivations for benzodiazepine misuse among the U.S. civilian, noninstitutionalized population aged 12 or older. While benzodiazepine use is highly prevalent among U.S. adults, benzodiazepine use disorders are relatively rare among benzodiazepine users. Our results help characterize benzodiazepine users and identify adults at risk for misuse and use disorders. Participants also gave examples of times when they felt prescribers minimized the risk of long-term use of a low dose or implied that the prescription was justified because of the serious nature of their situation.

For example, elderly patients whose daily activities require higher cognitive processing should be informed of BZD’s potential side effects on their cognitive processing speed. Patients with a history of addiction should prioritize alternative treatments to BZD therapy to prevent BZD dependence and abuse. Literature in the past 50 years presents contradicting evidence on whether BZD impairs cognitive functioning in the elderly (19–24). Among the studies that suggest an association between BZD use and cognitive impairment in elders, the type and degree of cognitive impairment reported are inconsistent across studies (19, 20, 22). Moreover, the neurological alterations due to the long-term effects of BZD use remains unclear (9).

In terms of anxiety, BZDs are used as a bridge when starting another medication or as abortive therapy for panic attacks. Given concerns for use dependence and withdrawal, SSRIs and antidepressants have been made mainstay therapy for these conditions. However, given their delayed onset of action, BZDs continue to be widely prescribed for these illnesses 12. Given their lipid solubility, BZDs have a high volume of distribution in the body, which translates to higher tissue concentrations than blood. After exerting their effect, BZDs are metabolized primarily by the liver and excreted by conjugation, so they should be used in caution in the elderly, smokers, and those with liver disease or damage 3. Due to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS pathology, muscle relaxation, and epilepsy.