Paper, Apr/22: Benzodiazepine and Z-hypnotic stewardship (by Dr. Steven Wright)

This article appeared in the Journal of Family Practice in April 2022, and it was written by Dr. Steven Wright, who is the former medical director of the Alliance for Benzodiazepine Best Practices, Portland, OR, a nonprofit resource for physicians and patients. Some BBs may be familiar with him already through that organization, through his writing or through some of the YouTube videos in which he appeared.

 

https://cdn.mdedge.com/files/s3fs-public/JFP07104103.PDF

 

Benzodiazepine and Z-hypnotic stewardship

These agents are not first-line treatments for many of theconditions for which they are used. When they are used, there should be a plan in place for deprescribing.

 

Note: The formatting of the article makes it very hard to copy and paste, so it's best to just click on the link in order to read it there. I will just include the very first part of the article here:

 

Benzodiazepines (BZDs) and Z-hypnotics have been

available for decades, yet uncertainties about their use

remain. They are prescribed and overprescribed most

often for anxiety and insomnia, for which they have value but

also the potential for significant adverse consequences, no-

tably physiologic dependence. Use of these agents should be

limited, and planned deprescribing is a fundamental aspect of

prescribing.

 

A brief history:

 

BZDs are a subset of benzodiazepine

receptor agonists (BZRAs), which enhance the inhibitory ef-

fect of centrally acting γ-amino butyric acid (GABA) at the

GABA A receptor through allosteric modulation. In 1960, the

first BZD, chlordiazepoxide, was marketed for clinical use,

and as other agents in the class became available, BZDs sup-

planted the more toxic barbiturates, another BZRA subset

(TABLE 1). By the late 1970s, BZDs had risen to the top of

most prescribed medications, with one agent in particular—

diazepam (Valium)—earning a reputation as “mother’s little

helper,” a phrase derived from a Rolling Stones' song with that

title produced in 1966. 1

 

With recognition of the problems associated with BZDs,

their popularity diminished somewhat but remained high.

BZDs were listed under Schedule IV by the Drug Enforcement

Administration in 1975 due to the risk for addiction, and on the

American Geriatrics Society Beers Criteria list in 1991 because

of significant adverse consequences in the elderly. Research-

ers began to question their use as early as the 1970s, and the

landmark Ashton Manual, guidance for patients and clinicians

alike, was published in 2002. 2

 

Currently, there are 14 BZDs approved by the Food and

Drug Administration (FDA) as well as 3 Z-hypnotics, termed

such as they include the letter “z” in their generic names

(TABLE 1). In recent years, BZD prescribing has risen; a

2019 study found that 1 of 8 American adults reported using a

BZD in the previous year.3

 

 

 

 

Appreciate you posting this.  It will be a good one to take to my skeptical doc who does not agree that withdrawal symptoms can persist for a long time. Thanks.

You're welcome. This doctor is also one of the editors of a book called The Benzodiazepines Crisis, which looks at many of the repercussions of over-prescription of benzos, including protracted withdrawal. I'll put in the link here, in case you're looking for more literature:

 

https://academic.oup.com/book/31739?login=false