The Misuse of Benzodiazepine

30 Jan 2018

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  1. Introduction

Benzodiazepine (BZD) misuse is a serious public health problem because it puts patients at higher risk of life-threatening drug overdoses for a long time.(Kevin W Chen,2011).In any case,the combination of effectiveness and risks of long-term use is the reason why BZD and other Tranquilizer drugs are too dangerous to deal with in clinical practice.Despite the fact that scientists have tried very hard to find an explanation for this issue, there is no recent study to assess how serious the problem is.However, BZD has killed a lot of people who use it for wrong purpose. The number of people taking prescribed BZD worldwide is considerable and over 1 million people in the UK are on long-term. (Dr Chris Ford,2014). For instance, Whitney Houston is the famous person who died because of BZD abuse. She died at the age of 48, which alarms the whole world .

Whiney Houston’s cause of death

(Xanax is one kind of Benzodiazepine)

BZD do not indicate for a long-term treatment of anxiety or insomnia like some people who have misunderstanded. Long-term use can cause withdrawal symptoms in many people. Withdrawal symptoms can be considered as including three main groups: anxiety symptoms, distorted perceptions and major incidents.Treatment can be divided into three options: talking therapies, cognitive behavioural therapies and self-help. Self-help is the most important in this three options so the result depends much on patient's endeavour.

  1. Situation

Benzodiazepines are a type ofmedicationknown as tranquilizers. Familiar names include Valium and Xanax. They are some of the most commonly prescribed medications in the United States. When people withoutprescriptionsobtain and take these drugs for their sedating effects, use turns into abuse.Scientific name of this symptom is Benzodiazepines misuse or Benzodiazepines drug abuse (Joseph Goldberg,2014). BZD is used by two main populations: low-dose prescribed benzodiazepine users and high-dose, non-prescribed benzodiazepine abusers.

In the first population, two kinds of patients who misuse the BZD are pointed out by Professor Heather Ashton in his scientific research about drug abuse.First, there are many patients who are prescribed BZD for short term but then using as long-term drugs by the instruction of doctors. As Professor Ashton mentioned in his book, this kind of patients estimated at 4 million people in the U.S. and it is likely that half of them are dependent.Four million people is quite a significant number that is enough to raise our attention on this issue. Morever, there are lots of patients who are prescribed BZD but then increase the dose on their own. “The more the better” is frequently a fundamental thinking of patients who misuse the dose of BZD.

Benzodiazepine abuse is a growing problem and carries serious risks to health and society.

Professor C Heather Ashton

In the second population, Non-prescribed benzodiazepine abusers (NBA) is the term used to describe patients who are use BZD for arbitrary purposes. Without the instruction of doctor, NBA use BZD frequently for recreational purpose that lead them to be addicted.

Table 1. Some benzodiazepines used recreationally (UK, Europe and USA)

Generic name

Brand name (UK)

Potency (approximate dose equivalent to 10mg diazepam)

Alprazolam

Xanax

0.5

Bromazepam

Lexotan

5

Chlordiazepoxide

Librium

25

Diazepam

Valium

10

Flunitrazepam

Rohypnol

1

Flurazepam

Dalmane

15-30

Ketazolam1

Anxon

15-30

Lorazepam

Ativan

1

Medazepam1

Nobrium

10

Nitrazepam

Mogadon

10

Oxazepam

Serenid

20

Prazepam1

Centrax

15

Temazepam

Normison, Euhypnos

20

Triazolam1

Halcion

0.5

(Zopiclone)2

Zimovane)

(15)

(Zolpidem)2

(Stilnoct)

(20)

Notes

  1. No longer in British National Formulary.
  2. Non-benzodiazepine hypnotics with similar actions to benzodiazepines; may have abuse liability.

In the US, flunitrazepam have become popular because of diversion of supplies across the Mexican border .Potent benzodiazepines such as triazolam (no longer available in the UK), alprazolam (widely prescribed in the US) and lorazepam have a good position in NBA’c choice.

These drugs are popular among sedatives such as valium (diazepam a particular pharmaceutical, like seduxen) and xanax (alprazolam scientific name, is a very powerful sedative often used in cases of severe insomnia ) has been misused and cause many adverse consequences. The use of sedatives such as drugs and marijuana to stimulate the brain has led to many scandals in the world of celebrity publicity curious about the effects of this class of drugs.Furthermore, some people not just use Benzodiazepine singly. According to the research of DAWN in 2002, there are 78% of user who have used more than one tranquiziler . Using several drugs at the same time as benzodiadepine, tranquilizers, narcotic, antidepressants, ... can cause drowsiness, falls and some other negative effect on your health that you would not know briefly.

  1. Problems

BZD rarely used as recreational drugs which make user feel “high” .In the recent research, BZD is described to be valued on the same level as Cocaine or Alcohol. There is no doubt that it is difficult to estimate the extent of their ability to induce euphoria with psychic dependence and active drug-seeking behavior.(Doctor Cole JO,1990)

The different types of BZD will have different effects on the body and on the extent of the time . Patients who use BZD simultaneously with heroin, alcohol or other addictive substances. The combined use of drugs is too dangerous because it is easy to lead to fatal cases for users.

Impact of BZD to users depends on the following factors:

  • The dose used (how many pills)
  • Height, weight of the user
  • Health status of users
  • Experience using drugs before
  • Have they used BZD with other addictive substances ?
  • How to use (oral or injection)
  • Using BZD individually or sharing with others
  • Using BZD at home or at party

Another study published in the BMJ paper in 2012 warned the wide use of benzodiazepine. The study concluded that the frequent use of drugs containing benzodiazepines are related to the risk of dementia.These studies have confirmed the use of benzodiazepines for long periods can adversely affect human perception and cause cognitive decline leading to dementia. The present study has shown the related connection between Benzodiazepines with the onset of dementia and Alzheimer's disease. Alzheimer is the most common form of dementia syndromeandits disease is a condition that affects the brain, thinking and human behavior. A study published in the British Medical Journal (BMJ) has considered the relationship between the risk of Alzheimer's disease and those who use benzodiazepines frequently. 1796 people,who were followed for a period of 5 years before they are tested, are diagnosed Alzheimer.

Benzodiazepines is addictive and can cause severe withdrawal symptoms. It activates neurotransmitters in the same way as opium and marijuana. When users stop taking antidepressant drugs, they become extremely anxious. Withdrawal is possible in most patients who are dependent on benzodiazepines once problems related to prolonged use of benzodiazepines and other drugs are explained and discussed. Consideration needs to be given as to when and how to detoxify and extra help and services may be needed. Many people depend on BZD drugs find out that decreasing the dose of Benzodiazepine is very difficult due to the appearance of a withdrawal syndrome when the expression of discomfort occurs due to abrupt discontinuation.

The manifestation of withdrawal syndrome include :

  • Seizures
  • Difficulty sleeping
  • Worry, anxiety, stress
  • Confusion and depression
  • Feeling anxious, think others want to harm you
  • Panic and feel extremely anxious
  • Alienated, do not want to be close to others.

Withdrawal symptoms can be dangerous. Besides affecting physical health, it also has a negative impact on the mental health of patients with symptoms caused prolonged and dangerous symptom for them.Since using BZD for a long period of time to satisfy the addiction, many patients died suddenly while using the drug.

FIGURE 1. Percentage of opioid pain reliever and benzodiazepine drug abuse–related emergency department visits in the United States and drug-related deaths in 13 states that involved alcohol, by age group — Drug Abuse Warning Network, 2010

The numbers in the chart FIGURE 1 are also the statistics of cancer patients who took an overdose of Benzodiazepine. In 2010, the percentage of ED visits that involved OPRs and alcohol was highest among persons aged 30–44 years (20.6%) and 45–54 years (20.0%).For the percentage of benzodiazepine ED visits was highest among persons aged 45–54 years (31.1%). Among OPR deaths, persons aged 40–49 years (25.2%) and 50–59 years (25.3%) had the highest percentage of alcohol involvement. For benzodiazepine-related deaths, the highest percentage (27.7%) was among persons aged ≥60 years.From the chart, it can be concluded that aged 45-54 are much needed medical care due to abuse Benzodiazepine.Anxiety is one of the reasons for people of this age often have to use Benzodiazepines regularly. Due to the nature of work and the burden of earning money that they constantly faced with the stress of work and life that makes them easy to fall into a state of stress, anxiety and insomnia also. Therefore, Benzodiazepines are frequently used as a drug to help them overcome such bad condition. Obviously, the use is so spontaneous, rarely comes from the prescription of doctors so it often causes serious problems affecting the health of workers. Long-term use easily become a habit and start adversely affect their health.It also lead to the problem that the chart showed above.Aged Upper 60 has the highest rate which means that Drug ,such as Benzodiazepine, is a major cause of their death. That is the consequence of using too much Benzodiazepine or some other Opioid Pain Relievers among the aged 30-44 and 45-54.

Generally , besides the beneficial effects to the treatment, there are many problems that Benzodiazepines cause to the users .

  1. Solution

When prescribed for severe insomnia or disabling anxiety, the guidance is clear that benzodiazepines should only be given for short-term relief (2–4 weeks), which may occur alone or in association with short-term psychosomatic, organic, or psychiatric illness. They should be used in the lowest dose and for the shortest time. Benzodiazepines and other similar drugs are not indicated for the long-term treatment of anxiety or insomnia, unless in rare cases where the patient has been proven to have treatment-resistant anxiety or insomnia, i.e. resistant to psychological therapies and nonaddictive medications. The decision to prescribe in these circumstances is usually made by a specialist. The use of benzodiazepines is inappropriate to treat short-term mild anxiety.

As mentioned in the Introduction part, talking therapies is one of useful cures for who suffer from withdrawal symptom. Talking therapies involve talking to someone who is trained to help you deal with your negative feelings. They can help anyone who is experiencing distress. You do not have to be told by a doctor that you have a mental health problem to be offered or benefit from a talking therapy. The therapy helps the patients facing their feelings and thoughts that lead them to feel insecure, afraid and the effect they have on their behaviour and mood. Describing what’s going on in your head can help you notice any patterns which it may be helpful to change.It can help you work out where your negative feelings and ideas come from and why they are there.

Understanding all this can help people make positive changes by thinking or acting differently. Talking therapies can help people to take greater control of their lives and improve their confidence so that people do not need any medicines like Benzodiazepine help themselves.(Mental Health Foundation)

For the second option , Cognitive behavioural therapy (CBT) is an effective treatment performed either individually or in small groups, and has been found in some cases not only to be as effective as short-term prescription medication but may last beyond the withdrawal fromactive treatment. Cognitive behavior therapy has become increasingly popular in recent years with both mental health consumers and treatment professionals. Because CBT is usually a short-term treatment option, it is often more affordable than some othertypes of therapy. CBT is also empirically supported and has been shown to effectively help patients overcome a wide variety of maladaptive behaviors.

The last treatmenat can be pointed out is self-help . Any illness will be cured very quickly if the patient attempts to overcome it. By increasing your self-awareness capabilities, self-help efforts can help you learn to recognize potential problems before they occur (or at least early on in their progression) so that you can head them off before they become substantial .This solution is really essential in treatment procedure . There is a quote : “If you try hard you can succeed in reaching your goal” . It is the truth that no one can disagree.

For more information, there are some basic solutions that people should know to have a good first aid for who suffer from overdose use of Benzodiazepine in emergency.

Overdose is a condition occurs when the dose exceeds the tolerance of the body. If only use pure benzo drugs, but if used in combination with other drugs such as alcohol, heroin, or methadone, is likely a drug overdose and death.

When someone with a drug overdose, besides the need to be alert and perform the following actions:

  • Call 115 victims immediately or take patient to the nearest medical facility.
  • Always on the side of the victim
  • Try to calm , do not panic
  • Find ways to keep victims province, helped victims go around, talk to the victim.
  • If the patient is unconscious, check if the victim is breathing or not. It is important to make clear the airway for the victim.
  • If the patient has stopped breathing, blow into the victim's mouth (CPR).
  • Let the patient lying on lean posture , then wait for an ambulance .
  1. Evaluation

The use of sedative drugs (ATGN) often remarkably effective, to quickly get deep sleep. However, overuse or prolonged use of this class of drugs often cause unwanted consequences, affect the health of users.

There are some solutions that I pointed out above which is really helpful for patients who misues Benzodiazepine . In my point of view, Talking therapies and self help are two main treatment that people can easily prefer , like what I mentioned in Introduction, self help has significant role in the process of treatment because no one can help you better than yourself . Self help often has some benefits :

  • Self help is free of cost. Patients do not have to pay for treatment since it is individual treatment.
  • Self help help patients intensify their brain’s work , steering themselves away from bad decision. Such as overusing Benzodiazepines.

Lance Armstrong is a practical example. In 1996, he was diagnosed with testicular cancer with a tumor has spread to the brain and lungs, and the initial prognosis is bad. The process of his cancer treatments included brain and testicular surgery, chemotherapy prolonged. Though suffering from the deadly disease but he overcame it in spectacular way to return to the race .In 1999, he won Tour de France for the first time and keep this position 7 times in a row, was recorded in the history of cycling. In conclusion, Lance overcame the cancer mainly because of his endeavour. He tried his best to maitain his spirit, his mind during the treatment and he was successful.

On the other hand, talking therapy is also a good choice for patients who suffer from using Benzodiazepine overdose that lead to withdrawal symptom. Talking about your thoughts and feelings can help you deal with times when you feel troubled about something. If you turn a worry over and over in your mind, the worry can grow.But talking about it can help you work out what is really bothering you and explore what you could do about it.Talking is an important part of our relationships. It can strengthen your ties with other people and help you stay in good mental health that is needed for the physical treatment .

  1. Conclusion

Benzodiazepine misuse is an international issue which alarms people all over the world. The number of dead people because of overusing Benzodiazepines ,which is stated in Figure 1 Chart, is really considerable. Patients and prescribers alike commonly understand benzodiazepines poorly. Generally, patients find them helpful and would like doctors to prescribe them but patients need to be made fully aware of the problems they cause, particularly long-term use. Just because benzodiazepines are effective and reduce suffering quickly, does not mean that they are the best treatment to give.As what I introduced, there is not just one problem by using Benzodiazepine overdose. Dementia, cancer and withdrawal symptoms are three problems that I mentioned in Part 4. People may take benzodiazepines to try to relax, reduce withdrawal symptoms involved with other drugs, or enhance the effects of another drug or substance. Young people may self-medicate for internal pain and distress. They may see their parents taking medication and think this ist he way to solve their own problems and become dependent on BZD. Self help and talking therapy is two good option of treatment that steer patient far away from drugs like Benzodiazepines. In conclusion, using risky drug ,like Benzodiazepine, frequently is not a good habit . Everything has 2 sides .Thus, how to use Benzodiazepine effetively is still be a difficult question for people.



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