The Benzodiazepines Crisis

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The Benzodiazepines Crisis

Edited by John Peppin, Joseph V. Pergolizzi, Robert B. Raffa, and Steven L. Wright

Abstract

When properly prescribed, benzodiazepines and related “Z” drugs, are usually safe and effective. However, some patients experience lack of efficacy, severe adverse effects, and/or protracted withdrawal symptoms. Unfortunately, there is no reliable way to predict outcome prior to treatment. Use has dramatically expanded, to the point where some experts suggest a disconnect with actual medical need. With increased and longer prescribing there has been a corresponding increase in the “down-side” of these drugs. Benzodiazepines, as all drugs, produce some degree of normal physiologic tolerance and physical dependence. But for some patients withdrawal can result in a bewildering array of symptoms, that can persist for protracted time periods, difficult to understand and live with. Although there is currently no clear mechanistic explanation, some potentials include alterations of receptor number, promoters of receptor protein synthesis or degradation, absorption, distribution, metabolism, and elimination, GABA_A-receptor function or subtype-distribution, or involvement of peripheral benzodiazepine binding/receptor sites. This book attempts to bring benzodiazepine use under a more rational paradigm and reduce the incidence of side-effects and drug–drug interactions (DDI). It is the first devoted to take on this responsibility. Use, overuse/misuse, side-effects, DDI, physiology, and withdrawal are reviewed by expert clinicians and basic scientists in-depth. The book challenges the medical community to take seriously the use of this class of drug and to ameliorate prescribing behavior. The case is made for limiting initiation and duration (2–4 weeks) of use, and careful, supported discontinuation. We laud and suggest increased research into this class of drug and it’s “down-side.”

Bibliographic Information

Publisher:: Oxford University Press

Print Publication Date:: Oct 2020

Print ISBN-13:: 9780197517277

Published online:: Nov 2020

DOI:: 10.1093/med/9780197517277.001.0001

Authors

John Peppin, editor Marion University, College of Osteopathic Medicine

Joseph V. Pergolizzi, editor NEMA Research

Robert B. Raffa, editor University of Arizona College of Pharmacy

Steven L. Wright, editor Mountain Medical Care

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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

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Front Matter
Chapter 1 Introduction: The Origins and Rise of BenzodiazepinesMichael M. Miller and John F. Peppin
Chapter 2 The Evolution of Benzodiazepine Receptor Agonists: Developments in Pharmacology and ToxicologyJamie L. Hansen and Timothy J. Atkinson
Chapter 3 Benzodiazepine Therapy: The Good, the Bad, and the UglyJeffrey Guina, Brian Merrill, and Jo Ann LeQuang
Chapter 4 Use of Benzodiazepines and Z-Drugs in the Geriatric PopulationJan M. Kitzen
Chapter 5 The Central Benzodiazepine ReceptorMichael H. Ossipov
Chapter 6 Benzodiazepine Receptors in the PeripheryRobert B. Raffa
Chapter 7 Drug Withdrawal: A Modern Motivational View and Neurobiological SubstratesGeorge F. Koob
Chapter 8 Benzodiazepine Withdrawal: Clinical AspectsSteven L. Wright
Chapter 9 Benzodiazepines and Pain ManagementJohn F. Peppin and Steven L. Wright
Chapter 10 The Regulatory History of Benzodiazepines in the Age of the Dark Web and Other ThreatsJohn J. Coleman
Chapter 11 Benzodiazepines Today and Tomorrow: What We Know and Don’t Know About ThemJohn J. Coleman
Chapter 12 In Search of Benzodiazepine GuidelinesJo Ann LeQuang
ConclusionJohn F. Peppin, Joseph V. Pergolizzi Jr., Robert B. Raffa, and Steven L. Wright
End Matter
- Disclosure Agreements
- Index

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date: 08 March 2021

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The Benzodiazepines Crisis

Edited by John Peppin, Joseph V. Pergolizzi, Robert B. Raffa, and Steven L. Wright

Abstract

Bibliographic Information

Authors

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Contents