Study, May/18: Pharmacological management of benzo withdrawal, dependence....

The full title of this American study is "Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation".

Excerpt from full study:

BZDs have a powerfully calming effect on the brain. BZDs can modulate GABA-A receptors as an agonist. GABA has a fantastic property of being an inhibitory neurotransmitter with the ability to reduce the excitability of neurons.7,8 BZD use can cause physical dependence and tolerance. BZDs can be misused, abused, or diverted. Several short-term trials have endorsed the effectiveness of BZDs for sleep, in addition to their clinical evidence in decreasing anxiety, increasing sedation, inducing muscle relaxation, and exerting antiseizure effects.9 After a period of 1–6 months of use, the abrupt cessation of BZDs can cause life-threatening seizures, delirium, and death.10

BZDs provoke fears of liability in the event of overdose and death; they also carry significant medical complications, such as memory impairment, vehicle accidents, falls, overdoses, and severe withdrawal symptoms, including life-threatening delirium. For these reasons, discontinuation of BZDs after a certain period of use and in cases of nonmedical or medical misuse is often indicated. There are several methods to discontinue BZDs, ranging from pharmacological management to psychotherapies, such as cognitive behavior therapy (CBT).11

Under the umbrella of pharmacological management, several broad categories of medications have been proposed, including anticonvulsants, antidepressants, antihypertensives, endogenous steroids, antiemetics, myorelaxants, anxiolytics, antihistamines, sleeping aids, barbiturates, BZD antagonists, long-acting BZDs, and plant-based derivatives. The efficacy of these medications is not robust, and although some are relatively safe to use, many have a narrow therapeutic index. Some of them can present compounded risks of severe, life-threatening side effects. It seems prudent to wean patients off BZDs from both an ethical and a liability perspective. This review addresses the pharmacological management of BZD discontinuation, expanding on efficacy, risks of addiction, and medical complications.

Abstract:

https://www.ncbi.nlm.nih.gov/pubmed/29713452 

Full Study:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896864/

The following sobering info from the full study hopefully reminds everyone here not only how dangerous benzos can be, but also how miraculous it is that we're all still here.

Stay strong and keep putting one foot in front of the other....

The number of individuals seeking treatment for problems related to BZD abuse is increasing and still on the rise, and after pain relievers (opioids), BZDs have been the drug class most frequently involved in drug-related suicide attempts.4 An estimated 440,000 emergency visits were reported for opiate abuse, and approximately 400,000 emergency visits included BZDs among the Drug Abuse Warning Network (DAWN) estimates in 2010.5 Deaths due to BZDs are not only attributed to the solitary use of the drug, but alcohol is also involved in BZD abuse, leading to emergency visits because of the comorbidity of alcohol and BZD abuse. The association of BZDs with alcohol multiplies the risk of life-threatening overdoses and death by central nervous system depression. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) analyzed 2010 data from 13 states on deaths related to opioid prescriptions, alcohol, and BZDs, and they found that alcohol was involved in both opiate and BZD drug-related deaths (approximately 22% of deaths were caused by BZDs).6 The number of deaths from BZDs trended upward (from 2002 to 2015) and it is higher for men than for women (Figure 2).