The harm associated with use of synthetic cannabinoids has had a direct impact on the utilisation of specialist alcohol and drug services in Auckland, New Zealand. Many clients with synthetic cannabinoid withdrawal symptoms required intensive support including medication and admission to an inpatient detoxification unit. Clients withdrawing from synthetic cannabinoids were the third largest group of clients admitted to inpatient detoxification services in Auckland, New Zealand, between May 2013 and May 2014.

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The discovery that clonazepam prescribed for the treatment of migraines caused obstructive sleep apnea led to a rapid taper of clonazepam and substitution of lorazepam.  Lack of accurate knowledge about the different pharmacokinetics and actions of different benzodiazepines at GABA-A receptors and the risks associated with rapid benzodiazepine withdrawal resulted in the development of the benzodiazepine protracted withdrawal syndrome. Moderately severe disability continued after 2 years. Insufficient knowledge about benzodiazepines and their withdrawal is a serious problem as doctors across the world are under extreme pressure to stop prescribing them but do not have an understanding of the potential perils involved. The pathophysiology of protracted withdrawal syndrome remains poorly understood and there is no recognised treatment.  Information about appropriate management of withdrawal and the protracted withdrawal syndrome are available on Professor Ashton’s website at www.benzo.org.uk.