Benzodiazepines
The
benzodiazepine family of depressants is used therapeutically to produce
sedation, induce sleep, relieve anxiety and muscle spasms, and to prevent
seizures. In general, benzodiazepines act as hypnotics in high doses,
anxiolytics in moderate doses, and sedatives in low doses. Of the drugs marketed
in the United States that affect central nervous system function,
benzodiazepines are among the most widely prescribed medications. Fifteen
members of this group are presently marketed in the United States, and about 20
additional benzodiazepines are marketed in other countries. Benzodiazepines are
controlled in Schedule IV of the CSA.
Short-acting
benzodiazepines are generally used for patients with sleep-onset insomnia
(difficulty falling asleep) without daytime anxiety. Shorter-acting
benzodiazepines used to manage insomnia include estazolam (ProSom®), flurazepam
(Dalmane®), temazepam (Restoril®), and triazolam (Halcion®). Midazolam
(Versed®), a short-acting benzodiazepine, is utilized for sedation, anxiety,
and amnesia in critical care settings and prior to anesthesia. It is available
in the United States as an injectable preparation and as a syrup (primarily for
pediatric patients).
Benzodiazepines
with a longer duration of action are utilized to treat insomnia in patients with
daytime anxiety. These benzodiazepines include alprazolam (Xanax®),
chlordiazepoxide (librium®), clorazepate (Tranxene®), diazepam (Valium®,
halazepam (Paxipam®), lorzepam (Ativan®), oxazepam (Serax®), prazepam (Centrax®),
and quazepam (Doral®). Clonazepam (Klonopin®), diazepam, and clorazepate are
also used as anticonvulsants.
Benzodiazepines
are classified in the CSA as depressants. Repeated use of large doses or; in
some cases, daily use of therapeutic doses of benzodiazepines is associated with
amnesia, hostility, irritability, and vivid or disturbing dreams, as well as
tolerance and physical dependence. The withdrawal syndrome is similar to that of
alcohol and may require hospitalization. Abrupt cessation of benzodiazepines is
not recommended and tapering-down the dose eliminates many of the unpleasant
symptoms.
Given
the millions of prescriptions written for benzodiazepines (about 100 million in
1999), relatively few individuals increase their dose on their own initiative or
engage in drug-seeking behavior. Those individuals who do abuse benzodiazepines
often maintain their drug supply by getting prescriptions from several doctors,
forging prescriptions, or buying diverted pharmaceutical products on the illicit
market. Abuse is frequently associated with adolescents and young adults who
take benzodiazepines to obtain a "high." This intoxicated state
results in reduced inhibition and impaired judgment. Concurrent use of alcohol
or other depressant; with benzodiazepines can be life threatening. Abuse of
benzodiazepines is particularly high among heroin and cocaine abusers. A large
percentage of people entering treatment for narcotic or cocaine addiction also
report abusing benzodiazepines. Alprazolam and diazepam are the two most
frequently encountered benzodiazepines on the illicit market.
Flunitrazepam
(Rohypnol®) is a benzodiazepine that is not manufactured or legally marketed in
the United States, but is smuggled in by traffickers. In the mid-1990s,
flunitrazepam was extensively trafficked in Florida and Texas. Known as "rophies,"
"roofies," and "roach," flunitrazepam gained popularity
among younger individuals as a "party" drug. It has also been utilized
as a "date rape" drug. In this context, flunitrazepam is placed in the
alcoholic drink of an unsuspecting victim to incapacitate them and prevent
resistance from sexual assault. The victim is frequently unaware of what has
happened to them and often does not report the incident to authorities. A number
of actions by the manufacturer of this drug and by government agencies have
resulted in reducing the availability and abuse of flunitrazepam in the United
States.
Newly
Marked Drugs
Zolpidem (Ambien®) and zaleplon (Sonata®) are two relatively new,
benzodiazepine-like CNS depressants that have been approved for the short-term
treatment of insomnia. Both of these drugs share many of the same properties as
the benzodiazepines and are in Schedule IV of the CSA.
Information
Courtesy of DEA
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