Long-term benzodiazepine users--a mixed bag

Views into Studies of Differences in Drinking Habits and Alcohol Problems between Sociodemographic Groups

In the alcohol research field, associations between alcohol consumption or problems and some basic sociodemographic variables–e.g., sex, age, socioeconomic status—are often presented. The first part of this paper discusses different uses of and views to such data on sociodemographic differences. The second part discusses different paths available to research when the aim is to get a more thorough understanding of the nature and origins of the associations observed. The conclusion is that even basic descriptive data on sociodemographic differences are useful and offer means to contribute to more general scientific discussions in the fields of alcohol policy, social policy, public health, sociology, etc. However, the more we are able to find out about why the differences exist and in what contexts they appear strongest, the more useful this information becomes and the more interesting the views offered by the analysis.

Ten-year trends in benzodiazepine use in the Dutch population

BACKGROUND

In the past decades knowledge on adequate treatment of affective disorders and awareness of the negative consequences of long-term benzodiazepine use increased. Therefore, a decrease in benzodiazepine use is expected, particularly in prolonged use. The aim of this study was to assess time trends in benzodiazepine use.

METHODS AND MATERIAL

Data from the Longitudinal Aging Study Amsterdam (LASA) were used to investigate trends in benzodiazepine use between 1992 and 2002 in two population-based samples aged 55-64 years. Differences between the two samples with respect to benzodiazepine use and to sociodemographic, physical health and mental health characteristics were described and tested with chi-square tests and logistic regression analyses.

RESULTS

Benzodiazepine use remained stable over 10 years, with 7.8% in LASA-1 (n = 874) and 7.9% in LASA-2 (n = 919) (p = 0.90) with a persisting preponderance in women and in people with low education, low income, chronic physical diseases, functional limitations, cognitive impairment, depression, anxiety complaints, sleep problems and when using antidepressants. Long-term use remained high with 70% in 1992 and 80% in 2002 of total benzodiazepine use.

CONCLUSION

In the Dutch population aged 55-64, overall benzodiazepine use remained stable from 1992 to 2002, with a high proportion of long-term users, despite the effort to reduce benzodiazepine use and the renewal of the guidelines. More effort should be made to decrease prolonged benzodiazepine use in this middle-aged group, because of the increasing risks with ageing.

Uso indevido de benzodiazepínicos: um estudo com informantes-chave no município de São Paulo

Este estudo teve por objetivo compreender a prática de prescrição, dispensação e uso prolongado de benzodiazepínicos, a partir da visão de profissionais de saúde e de usuários crônicos dessas substâncias. A amostra foi composta por técnica de bola de neve, totalizando19 informantes-chave. As entrevistas semi-estruturadas foram gravadas e transcritas para análise. A maioria dos entrevistados relatou ser freqüente a obtenção de prescrição de benzodiazepínicos por solicitações junto aos médicos, sem necessidade de consulta formal. Os usuários relataram histórico de uso prolongado (entre 2 e 8 anos) com finalidades outras que não apenas a terapêutica. Enfatizaram também a facilidade em adquirir a medicação e a falta de orientação médica sobre os cuidados necessários durante o tratamento. O estudo sugere que a ocorrência de uso indevido envolve não apenas o sistema de controle da dispensação, mas uma série de outros fatores, entre os quais as atitudes dos profissionais de saúde.

Psychological distress and adaptational problems associated with discontinuation of benzodiazepines

This study compared subjects who had received standard tapered withdrawal of benzodiazepine (BZD) (group 1) with a group with comparable diagnosis still receiving BZD (group 2) and a control group of comparable diagnosis not yet receiving treatment (group 3). Sixty subjects aged 21-65 years with a diagnosis of nonpsychotic anxiety or insomnia were included. The assessment of psychological distress and quality of life was timed to coincide with the maximum immediate effect of BZD discontinuation, as calculated according to drug half-life. Subjects diagnosed with insomnia reported lower distress in all three groups. The pattern of distress experienced by group 1 was closer to group 3 than to group 2, indicating the potential importance of re-emergence of anxiety. High neuroticism, lower education level, and lower quality of life were associated with higher levels of distress during withdrawal.

Anxiolytic and hypnotic use by general hospital inpatients. The impact of psychopathology and general medical conditions

This study explored the relative impact of general medical conditions and psychopathology on the current and lifetime use of anxiolytic and/or hypnotic drugs by general hospital inpatients. One hundred and five consecutive patients, admitted to an internal medicine department, were assessed by a structured interview about current and lifetime use of anxiolytic and/or hypnotic drugs, and with somatic and psychopathology scales. Eighty percent of patients reported using anxiolytics and/or hypnotics at least once in a lifetime, 62.9% in the last year, 55.2% in the last 3 months, and 42.9% in the last week. Correlations were found between drug use and current levels of anxiety and depression, but not somatic pathology. Psychological suffering appeared to be a major determinant for anxiolytic and/or hypnotic use by patients with general medical conditions. Consumption rates were higher than in the general population, but there was no direct link between somatic morbidity and drug use.

Analyses of use of tranquilizers and sleeping pills across five surveys of the same population (1985-1991): the relationship with gender, age and use of other substances

The present study used analyses of data from five surveys of the same population over a 6-year period to examine the relationship of use of tranquilizers/sleeping pills with gender, age and use of other psychoactive substances. Part of the study involved identifying methodological issues in using surveys to study tranquilizer/sleeping pill use. Across surveys and within all age groups, females were more likely to use tranquilizers and/or sleeping pills than males, with an average ratio overall of a little higher than three to two (varying across surveys from 1.4 to 2.1; mode of 1.6). Prevalence rates for both females and males were strongly affected by timeframe over which use was measured. Use of tranquilizers/sleeping pills increased with age; however, the relationship with age was different for tranquilizers than for sleeping pills. For tranquilizers, the high correlation between age and use was largely attributable to the low rate of use by those aged 34 and younger. For sleeping pills, on the other hand, the relationship is based more on the high rate of use by those aged 65 and older. In addition, age was a major factor in nonmedical use of tranquilizers/sleeping pills, with nonmedical use decreasing dramatically with age. Use of other types of psychoactive medications was significantly higher among tranquilizer/sleeping pill users than among non-users. The results pertaining to concurrent use of tranquilizers/sleeping pills and alcohol, marijuana, and tobacco, however, showed some trends, but findings were not consistent across all surveys. Further analyses suggested that this lack of consistent findings might be attributable to survey design issues, in particular, the extent that the format of the survey question tended to exclude nonmedical users. The implications of these results for future research on tranquilizer/sleeping pill use are discussed.

Is work a risk factor in the prescribed psychotropic drug consumption of female white-collar workers and professionals?

This article provides information on the prevalence and the characteristics of consumption of prescribed psychotropic drugs among unionized female white-collar workers and professionals in Montreal Canada. The objective of this paper is also to raise hypotheses on the contribution of certain professional factors to women's long-term use of psychotropic prescribed drugs. Data were collected through a questionnaire mailed to participants' homes. Results showed that prescribed psychotropic drugs are being used in the context of work. About 15% of the working women did use prescribed psychotropic drugs during the twelve months preceding the survey, and 5% of respondents reported a high level of consumption. Working women had a tendency to maintain consumption practices in line with their doctor prescription. Results also suggest that the work environment influenced prescribed drug consumption.

A comparison of the acute behavioral effects of flunitrazepam and triazolam in healthy volunteers

Flunitrazepam is an hypnotic benzodiazepine marketed in different European countries. Epidemiological studies have shown that it is frequently abused by opioid addicts. In a survey, "liking" scores for flunitrazepam in methadone maintenance patients were higher than ratings for other benzodiazepines. A double-blind, placebo controlled, crossover clinical trial was conducted to assess the acute behavioral effects of flunitrazepam (0.50 and 2 mg) and triazolam (0.25 and 0.50 mg) in healthy male volunteers. Drug effects on physiological measures, psychomotor performance, and subjective rating scales, including specific questionnaires to evaluate abuse liability (e.g., ARCI or "liking" scores), were assessed before and 6 h after drug administration. Flunitrazepam 2 mg produced the most intense disruptive effects on all the performance tasks, triazolam 0.50 impaired performance except balance. All study drugs at all doses produced sedation symptoms in all or part of the subjective effects questionnaires. Only flunitrazepam 2 mg induced significative increases in some of the scales ("liking", "good effects", "high") that could be related to a possible abuse potential. The results seem to indicate that flunitrazepam, when administered to healthy subjects, produces some pleasurable subjective feelings, that could indicate a higher abuse liability of this drug as compared with other benzodiazepines.