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Baudot FO. Impact of benzodiazepine use on the risk of occupational accidents. PLoS One 2024; 19:e0302205. [PMID: 38626122 PMCID: PMC11020385 DOI: 10.1371/journal.pone.0302205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/31/2024] [Indexed: 04/18/2024] Open
Abstract
Benzodiazepines (BZDs) are drugs commonly used for treating insomnia and anxiety. Although they are known to induce cognitive and psychomotor impairments, their effect on the risk of causing accidents at work remains understudied. The objective of this study is to estimate this risk by differentiating between the recommended use and overuse of these drugs (i.e., uninterrupted use for four months). The data come from the French National Health Data System, which provide a population composed of French people who had at least one work accident (WA) from 2017 to 2019 (approximately 2.5 million people). A linear probability model with two-way fixed effects is used to deal with time-constant heterogeneity and the time effect independent of individuals. The results show a reduction in the risk of WA after a short period of BZD use (one month) compared with no use at all, but the risk of WA increases when treatment exceeds the recommended duration. The intensity of use results in a greater risk of WAs: a 1% increase in BZD use (expressed as the amount reimbursed) leads to a 4.4% (p<0.001) increase in the monthly risk of WAs. Moreover, we see an increase in risk in the month following the treatment discontinuation (+3.6%, p<0.001), which could be due to rebounding and catch-up effects. Health professionals and BZD users should be made aware of the WA risk induced by the use of BZDs, particularly after prolonged use and after discontinuation of treatment. This study provides more evidence for the need to limit the duration of BZD treatment.
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Affiliation(s)
- François-Olivier Baudot
- ERUDITE, Université Paris-Est Créteil, Créteil, France
- Caisse Nationale de l’Assurance Maladie, Paris, France
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Barnay T, Baudot FO. Work accident effect on the use of psychotropic drugs: the case of benzodiazepines. HEALTH ECONOMICS REVIEW 2023; 13:48. [PMID: 37872453 PMCID: PMC10594863 DOI: 10.1186/s13561-023-00464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND A work accident constitutes a shock to health, likely to alter mental states and affect the use of psychotropic drugs. We focus on the use of benzodiazepines, which are a class of drugs commonly used to treat anxiety and insomnia. Prolonged use can lead to dependence. Our objective is to determine the extent to which work accidents lead to benzodiazepine use and overuse (i.e. exceedance of medical guidelines). METHOD We use a two-step selection model (the Heckman method) based on data from the French National Health Data System (Système National des Données de Santé, SNDS). Our study sample includes all general plan members who experienced a single work accident in 2016 (and not since 2007). This sample includes 350,000 individuals in the work accident group and more than 1.1 million people randomly drawn from the population without work accidents from 2007 to 2017 (the non-work accident group). RESULTS The occurrence of a work accident leads to an increase in benzodiazepine use and overuse the following year. The selection model shows a clear influence of the accident on the use probability (+ 39%), but a very slight impact on the risk of overuse among users (+ 1.7%), once considered the selection effect. The effect on overuse risk is higher for more severe accidents and among women. CONCLUSION The increase in the risk of benzodiazepine overuse is due to an increase in the likelihood of using benzodiazepines after a work accident that leads to overuse, rather than an increase in likelihood of overuse among people who use benzodiazepines. Results call for targeting the first-time prescription to limit the risk of overuse after a work accident.
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Affiliation(s)
- Thomas Barnay
- ERUDITE, Université Paris-Est Créteil, 61 Avenue du Général de Gaulle, Créteil, 94010, France
| | - François-Olivier Baudot
- ERUDITE, Université Paris-Est Créteil, 61 Avenue du Général de Gaulle, Créteil, 94010, France.
- Direction de la Stratégie, des Études et des Statistiques, Caisse Nationale de l'Assurance Maladie, 50 Avenue du Professeur André Lemierre, Paris, 75986, France.
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Lugg W. Scrutinising the evidence for long term benzodiazepine use in anxiety - response to Tibrewal et al. Aust N Z J Psychiatry 2022; 56:721-723. [PMID: 35083918 DOI: 10.1177/00048674211073042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- William Lugg
- Department of Psychiatry, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Mansueto G, Lugoboni F, Casari R, Bertoldi A, Cosci F. Mono- and poly-therapy with benzodiazepines or Z-drugs: Results from a tertiary-care Addiction Unit study. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2021; 32:295-320. [PMID: 34120917 DOI: 10.3233/jrs-210014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Using benzodiazepines (BZDs) or Z-drugs in poly-therapy is a critical issue. OBJECTIVE Identifying factors influencing the use of BZDs/Z-drugs in poly- vs mono-therapy in patients with or without substance use disorders (SUDs). METHODS 986 inpatients were analysed. Socio-demographic and clinical variables were collected. BZD/Z-drug doses were compared via the Defined Daily Dose (DDD) and standardized as diazepam dose equivalents. Mann-Whitney, Chi-square, Fisher test, hierarchical multivariate regression analyses were run referring to the whole sample and to subjects with current SUDs, lifetime SUDs, current and lifetime SUDs, non-SUDs. RESULTS In the whole sample the variance of being mono- vs poly-therapy users was explained by BZD/Z-drug formulation, DDD, duration of treatment, age of first BZDs/Z-drugs use (ΔR2 = 0.141, p < 0.001). Among those with current SUDs (ΔR2 = 0.278, p = 0.332) or current and lifetime SUDs (ΔR2 = 0.154, p = 0.419), no variables explained the variance of being mono-vs poly-therapy users. Among lifetime SUDs subjects, the variance of being mono- vs poly-therapy users was explained by BZD/Z-drug formulation and age of first BZD/Z-drug use (ΔR2 = 0.275, p < 0.001). Among non-SUDs subjects, the variance of being mono- vs poly-therapy users was explained by DDD and duration of treatment (ΔR2 = 0.162, p = 0.001). CONCLUSIONS Tablets, high drug doses, long duration of treatment, and early age of first use were more likely associated to poly- than mono-therapy. This suggests that patients have different clinical features and a pharmacological prescription should be tailored to them also based on the variables here analysed.
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Affiliation(s)
- Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy.,Clinical Pharmacopsychology Laboratory, University of Florence, Florence, Italy.,Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Fabio Lugoboni
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Rebecca Casari
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Anna Bertoldi
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Clinical Pharmacopsychology Laboratory, University of Florence, Florence, Italy.,Department of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
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The Relevance of Dual Diagnoses among Drug-Dependent Patients with Sleep Disorders. J Clin Med 2020; 9:jcm9092862. [PMID: 32899692 PMCID: PMC7565704 DOI: 10.3390/jcm9092862] [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: 07/30/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Sleep disorders are often associated with drug use. Nearly 70% of patients admitted for detoxification report sleep problems. Dual disorder (DD) is the comorbidity between mental disorders in general and disorders related to psychoactive substance use. The association between substance use and sleep disorders (SD) appears to be bidirectional. Our objective is to analyze the association between sleep disturbance history and drug use pattern (alcohol, cannabis, opioids, and cocaine). METHODS Analysis of data in the first interview at the Addictions Unit of the Department of Psychiatry at the University of Salamanca Health Care Complex between October 2017 and January 2020. The sample consists of 398 patients. We studied the association between different variables: origin of patients (Inpatient Dual Diagnosis Detoxification Unit (IDDDU) vs. Outpatient Drug Clinic (ODC), presence of affective disorder, psychotic disorder, type of drug used, and treatment. RESULTS Of patients with DD, 62% had more delayed sleep induction, sleep fragmentation, early awakening, and nightmares. Outpatients had more difficulty falling asleep because, in many cases, they had not previously sought any medical assistance. On the other hand, 67% of the patients with insomnia presented depression. CONCLUSIONS There is evidence of a harmful association between DD and SD.
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Combatting the misuse of benzodiazepines and related Z drugs in French general practice: a clinical review. BJGP Open 2020; 4:bjgpopen20X101014. [PMID: 32127364 PMCID: PMC7330199 DOI: 10.3399/bjgpopen20x101014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/13/2019] [Indexed: 12/04/2022] Open
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Azzi L, Veronesi G, Tagliabue A, Croveri F, Maurino V, Reguzzoni M, Tettamanti L, Protasoni M, Spadari F. Is there an association between drugs and burning mouth syndrome? A case-control study. Oral Dis 2019; 25:1634-1644. [PMID: 31066953 DOI: 10.1111/odi.13116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this case-control study was to compare the pharmacological anamnesis collected from a group of 150 burning mouth syndrome (BMS) patients with that of a control group of 150 patients matched for age and sex. MATERIALS AND METHODS The patients' medical histories were reviewed, and data on drug therapy were collected. Drugs were classified on the basis of pharmacological effects; the classes were antihypertensives (i.e., ACE inhibitors/ARBs, calcium antagonists, diuretics and beta-blockers), antiaggregants, anticoagulants, antidiabetics, vitamin D integrators, bisphosphonates, psychotropics (i.e., anxiolytics and antidepressants), gastroprotectors, statins, thyroid hormone substitutes, corticosteroids and immunosuppressants. RESULTS The BMS patients and the controls were matched for age (mean age: 69 years) and sex (128 females and 22 males). Antihypertensives, especially ACE inhibitors/ARBs (OR = 0.37, CI: 0.22-0.63, p = 0.0002) and beta-blockers (OR = 0.36, CI: 0.19-0.68 p = 002), revealed an inverse association with the presence of BMS, whereas anxiolytics (OR = 3.78, CI: 2.12-6.75 p < 0.0001), but neither antidepressants nor antipsychotics, were significantly associated with BMS. There were no correlations with other drug classes. CONCLUSION Our study highlighted that ACE inhibitors, ARBs and beta-blockers were in inverse relation to BMS and found that anxiolytics, but neither antidepressants nor antipsychotics, were linked to the presence of the syndrome.
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Affiliation(s)
- Lorenzo Azzi
- Unit of Oral Medicine and Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Angelo Tagliabue
- Unit of Oral Medicine and Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Fabio Croveri
- Unit of Oral Medicine and Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Vittorio Maurino
- Unit of Oral Medicine and Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Marcella Reguzzoni
- Unit of Human Morphology, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Lucia Tettamanti
- Unit of Oral Medicine and Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Marina Protasoni
- Unit of Human Morphology, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Francesco Spadari
- Unit of Oral Pathology and Medicine, Maxillo-facial and Dental Unit, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Aouizerate B, El-Hage W. [Only good therapeutic strategies! Response to the letter about the special issue: "All the truth about benzodiapzépines"]. Presse Med 2019; 48:217-218. [PMID: 30853283 DOI: 10.1016/j.lpm.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bruno Aouizerate
- Pôle de psychiatrie générale et universitaire, centre hospitalier Charles Perrens, centre expert dépression résistante FondaMental, 33000 Bordeaux, France; Université de Bordeaux, NutriNeuro, UMR Inra 1286, 33000 Bordeaux, France
| | - Wissam El-Hage
- CHRU de Tours, centre expert dépression résistante FondaMental, 37000 Tours, France; Université de Tours, U1253, iBrain, Inserm, 37000 Tours, France.
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